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Drug-induced peripheral edema
Other Resources UpToDate PubMed

Drug-induced peripheral edema

Contributors: Sigriet Ferrer MLIS, Eric Ingerowski MD, FAAP
Other Resources UpToDate PubMed

Synopsis

Peripheral edema refers to fluid accumulation trapped in tissues of the extremities, resulting in swelling. Peripheral edema usually presents in the lower extremities (ankles, feet, and legs) and rarely occurs in the upper extremities (arms and hands).

Drug-induced peripheral edema can present acutely, as early as 1-3 days after starting a new medication. It may also occur chronically over time, from months to 1 year after initiating treatment.

Chronic peripheral edema can present with decreased range of motion, pain, and weakness. Substantial amounts of swelling can present acutely, over the span of hours, or chronically, increasing slowly and gradually over days, weeks, or months.

Peripheral edema is composed of 4 primary mechanisms: specifically, increased capillary permeability (permeability edema), lymphatic insufficiency (lymphedema), precapillary arteriolar vasodilation (vasodilatory edema), and sodium and/or water retention (renal edema).

Drugs may commonly cause or worsen peripheral edema via different mechanisms of action due to decreased oncotic pressure (low protein), impaired lymphatic drainage, and increased capillary permeability and hydrostatic pressure.

Certain classes of drugs are more commonly implicated in causing peripheral edema:
  • Alpha-adrenergic agonists
  • Anticonvulsants
  • Antidepressants
  • Antidiabetics
  • Antiepileptics
  • Antihypertensives
  • Antimicrobials
  • Antineoplastic antimicrotubular
  • Antiparkinsonian drugs
  • Antipsychotics
  • Aromatase inhibitors
  • Calcium channel blockers (CCBs)
  • Corticosteroids
  • Cytokines
  • Direct vasodilators
  • Endothelin receptor antagonists (ERAs)
  • Hormones
  • Immunosuppressants
  • Monoamine oxidase inhibitors (MAOIs)
  • NSAIDs
  • Opioids
  • Prostacyclin analogs
  • Protein kinase inhibitors (PKIs)
  • Proton pump inhibitors (PPIs)
  • Selective estrogen receptor modulator (SERMs)
  • Tyrosine kinase inhibitors (TKIs)
CCBs, endocrine drugs, and other vasodilators are the most implicated drug classes in peripheral edema.

Codes

ICD10CM:
R60.9 – Edema, unspecified
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

SNOMEDCT:
271809000 – Peripheral edema
278993004 – Drug-induced

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Last Reviewed:07/24/2024
Last Updated:08/05/2024
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Drug-induced peripheral edema
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A medical illustration showing key findings of Drug-induced peripheral edema
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