Medications That Can Cause Drug-Induced Lupus

High-Risk Medications

Hydralazine is associated with drug-induced lupus-like syndrome, especially at higher doses, according to the American Heart Association 1, 2
Isoniazid can cause drug-induced lupus as a rare adverse effect, with approximately 22% of patients treated for a mean of 6 months developing antinuclear antibodies, as reported by the British Thoracic Society 3

TNF-α inhibitors, such as Etanercept, Adalimumab, and Infliximab, can cause drug-induced lupus without renal or CNS complications, as stated by the American Academy of Dermatology 4
TNF-α inhibitor-induced lupus may involve renal complications, as noted by the American Heart Association 2

Drug-induced lupus typically presents with arthralgia/arthritis, pleurisy, rashes, and fever, as described by the American Academy of Dermatology 4
Traditional drug-induced lupus rarely involves the kidneys, as reported by the American Academy of Dermatology 4

For patients on isoniazid, monitoring for symptoms such as arthralgia, fever, and pleuritis is recommended, as suggested by the British Thoracic Society 3

Hydralazine produces a lupus-like syndrome that can include glomerulonephritis and requires immediate discontinuation unless the benefit-to-risk ratio necessitates continued therapy, according to the American Academy of Pediatrics 5
Hydralazine causes lupus-like syndrome particularly in slow acetylators at higher doses, and symptoms may persist for years after discontinuation, sometimes requiring long-term steroid therapy, as reported by the American Academy of Pediatrics 5

The American Academy of Dermatology notes that TNF-α inhibitor-induced lupus presents differently from traditional drug-induced lupus and may include renal complications, with development of or increase in circulating antinuclear antibodies, and several reported cases of patients developed signs and symptoms of systemic lupus erythematosus while receiving anti-TNF therapy 6

In patients receiving hydralazine—particularly at higher doses and in individuals who are genetically slow acetylators—the drug is one of the most common triggers of drug‑induced lupus; the syndrome may include glomerulonephritis and requires immediate discontinuation of the medication. [7][8]

D‑penicillamine can produce a late‑onset lupus‑like syndrome marked by hematuria, proteinuria, and positive antinuclear antibodies in approximately 20‑30 % of treated patients; the reaction typically develops after prolonged use and mandates prompt drug withdrawal when renal involvement is detected. [7][8]9

When changing from a tetracycline antibiotic, clinicians should avoid other tetracyclines and be aware that substituting any of the high‑risk agents listed above (e.g., hydralazine, procainamide, isoniazid, D‑penicillamine) may increase the risk of drug‑induced lupus. [10][11]