What are causative agents of fixed drug eruptions (FDE)?

Updated: Oct 09, 2020
  • Author: David F Butler, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

The major categories of causative agents of fixed drug eruption include antibiotics, antiepileptics, nonsteroidal anti-inflammatory agents, sildenafil, and phenothiazines, although numerous other agents and certain foods such as cashews and licorice have also been reported as causative agents. Ingestion of the causative agent may occur via any route, including oral, rectal, or intravenous. [17, 18]

Certain classes of drugs with cross-reactions within a class have been reported to elicit a fixed drug eruption with quinolones [19] and with nonsteroidal anti-inflammatory agents. [20] In some patients, the reaction may be to a dye rather than the active ingredient. [21] Fixed drug eruption may rarely be related to foods, including residual antibiotics in meat products and quinine contained in tonic water. [22, 23]

While fixed drug eruptions are uncommon with general anesthesia, propofol has been implicated in causing a drug eruption on the penis. [24]

The most common cause is trimethoprim-sulfamethoxazole. [3, 25] Other substances implicated to cause fixed drug eruptions are as follows [1, 13, 17, 26, 5, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41] :

Table. Substances Implicated in Fixed Drug Eruptions (Open Table in a new window)

Acetaminophen

Acyclovir

Allopurinol

Allylisopropyl-acetylurea

Amide local anesthetics

Amlexanox

Amoxicillin

Anticonvulsants

Articaine

Aspirin

Atenolol

Barbiturates

Botulinum toxin

Carbamazepine

Cashew nut

Ceftriaxone

Celecoxib

Cetirizine

Chloral hydrate

Chlordiazepoxide

Chlorhexidine

Chlormezanone

Chlorphenesin carbonate

Citicoline

Clarithromycin

Clioquinol

Clopidogrel

Codeine

Colchicines

Cyclizine

Cyproterone acetate

Dextromethorphan

Dimenhydrinate

Diphenhydramine

Dipyrone

Docetaxel

Eperisone hydrochloride

Erythromycin

Ethenzamide

Feprazone

Finasteride

Flecainide

Fluconazole

Fluoroquinolones

Foscarnet

Gabapentin

Griseofulvin

Hydroxyzine

Ibuprofen

Interferon

Iodinated radiography contrast media

Iomeprol

Kakkon

Ketoconazole

Lactose

Lamotrigine

Lentils

Liquorice

Lomeprol

Lopamidoln

Loratadine

Lormetazepam

Magnesium trisilicate

Mefenamic acid

Melatonin

Methaqualone

Metramizole

Metronidazole

Metaform

Minocycline

Multivitamins

Naproxen

Nimesulide

Omeprazole

Ondansetron

Opium alkaloids

Oxyphenbutazone

Paclitaxel

Pamabrom

Papaverine

Para-aminosalicylic acid

Penicillins

Phenazone

Phenolphthalein

Phenylbutazone

Phenylephrine

Phenylpropanolamine

Phenytoin

Pipemidic acid

Piroxicam

Procarbazine

Prochlorperazine

Pseudoephedrine

Quinine

Rifampin

Scopolia

Sodium benzoate

Strawberries

Sulfamethoxazole

Tartrazine

Terbinafine

Tetracyclines

Theophylline

Thiacetazone

Ticlopidine

Tinidazole

Tolfenamic acid

Tosufloxacin

Tranexamic acid

Trimethoprim

Tropisetron


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