Various drugs are associated with adverse respiratory disorders (ARDs) ranging in severity from mild, moderate to severe and even fatal. Cardioselective and nonselective beta-blockers,
calcium antagonists and
dipyridamole can induce
asthma.
ACE inhibitors are mainly associated with
cough.
Amiodarone is related to a form of
interstitial pneumonitis (IP) which can be fatal, tocainidine and flecainidine to a form of IP, and
hydrochlorothiazide to a form of IP and pulmonary oedema.
Antiasthmatic drugs can be associated with a paradoxical
bronchospasm, while
leukotriene antagonists are linked to the development of
Churg-Strauss syndrome. Nonsteroidal anti-inflammatory drugs including
aspirin (
acetylsalicylic acid) may induce
asthma.
Gold is mainly related to IP,
penicillamine to IP,
systemic lupus erythematosus,
bronchiolitis obliterans, and
Goodpasture's syndrome. Acute respiratory reactions to
nitrofurantoin include dyspnoea,
cough, IP, and
pleural effusion while IP and
fibrosis are common in chronic reactions. Other antibacterials mainly evoke
pneumonitis, pulmonary infiltrates and
eosinophilia, and
bronchiolitis obliterans. ARDs are similar for most categories of
cytotoxic agents, with chronic
pneumonitis and
fibrosis being the most common. Noncardiogenic pulmonary oedema occurs as the most common respiratory complication in
opioid agonist addiction.
Psychotropic drugs such as phenothiazides,
butyrophenones and
tricyclic antidepressants can also induce pulmonary oedema.
Oral contraceptives may produce
asthma exacerbation, while long term use and/or high doses of
postmenopausal hormone replacement therapy increase the risk of
asthma.
Bromocriptine is mainly associated with
pleural effusion, while
methysergide is usually associated with
pleural effusion and
fibrosis. Some
anorectic agents have been linked to the development of
primary pulmonary hypertension. The possibility of the occurrence of ARDs should be taken into account in each individual patient. Although in most cases the adverse effects are unpredictable, they can be reduced to a minimum or prevented if some drugs are avoided or stopped in time.