A 79-year-old male presented to the general medicine department with one-month history of pitting edema of the dorsum of the hands and lower legs. The patient had no recent history of such an episode. On arrival, his vital signs were as follows: Glasgow Coma Scale, E4V5M6; body temperature, 36.6?C; blood pressure, 146/84 mmHg; heart rate, 87 beats/min; respiratory rate, 16 breaths/min; and oxygen saturation, 97% on room air. Laboratory investigations and imaging revealed no remarkable findings. After loxoprofen was prescribed by the orthopedic department for lower back pain, edema developed. Drug-induced edema due to loxoprofen was suspected and, approximately 1 month after discontinuing the drug, the edema fully disappeared. This report aims to raise awareness among physicians, who should consider the possibility of a drug causing symptoms such as edema.
References
[1]
Trayes, K.P., Studdiford, J.S., Pickle, S. and Tully, A.S. (2013) Edema: Diagnosis and Management. American Family Physician, 88, 102-110.
[2]
Besharat, S., Grol-Prokopczyk, H., Gao, S., Feng, C., Akwaa, F. and Gewandter, J.S. (2021) Peripheral Edema: A Common and Persistent Health Problem for Older Americans. PLOSONE, 16, e0260742. https://doi.org/10.1371/journal.pone.0260742
[3]
Moffatt, C.J., Franks, P.J., Doherty, D.C., Williams, A.F., Badger, C., Jeffs, E., et al. (2003) Lymphoedema: An Underestimated Health Problem. QJM, 96, 731-738. https://doi.org/10.1093/qjmed/hcg126
[4]
Dai, M., Nakagami, G., Sugama, J., Kobayashi, N., Kimura, E., Arai, Y., et al. (2019) The Prevalence and Functional Impact of Chronic Edema and Lymphedema in Japan: LIMPRINT Study. LymphaticResearchandBiology, 17, 195-201. https://doi.org/10.1089/lrb.2018.0080
[5]
Walker, C. and Biasucci, L.M. (2017) Cardiovascular Safety of Non-Steroidal Anti-Inflammatory Drugs Revisited. PostgraduateMedicine, 130, 55-71. https://doi.org/10.1080/00325481.2018.1412799
[6]
Makani, H., Bangalore, S., Romero, J., Htyte, N., Berrios, R.S., Makwana, H., et al. (2011) Peripheral Edema Associated with Calcium Channel Blockers: Incidence and Withdrawal Rate—A Meta-Analysis of Randomized Trials. JournalofHypertension, 29, 1270-1280. https://doi.org/10.1097/hjh.0b013e3283472643
[7]
Naranjo, C.A., Busto, U., Sellers, E.M., Sandor, P., Ruiz, I., Roberts, E.A., et al. (1981) A Method for Estimating the Probability of Adverse Drug Reactions. ClinicalPharmacologyandTherapeutics, 30, 239-245. https://doi.org/10.1038/clpt.1981.154
[8]
Arakawa, T., Fujiwara, Y., Sollano, J.D., Zhu, Q., Kachintorn, U., Rani, A.A., et al. (2009) A Questionnaire-Based Survey on the Prescription of Non-Steroidal Anti-Inflammatory Drugs by Physicians in East Asian Countries in 2007. Digestion, 79, 177-185. https://doi.org/10.1159/000211713
[9]
Hersh, E.V., Moore, P.A. and Ross, G.L. (2000) Over-the-counter Analgesics and Antipyretics: A Critical Assessment. ClinicalTherapeutics, 22, 500-548. https://doi.org/10.1016/s0149-2918(00)80043-0
[10]
Riendeau, D., Salem, M., Styhler, A., Ouellet, M., Mancini, J.A. and Li, C.S. (2004) Evaluation of Loxoprofen and Its Alcohol Metabolites for Potency and Selectivity of Inhibition of Cyclooxygenase-2. Bioorganic&MedicinalChemistryLetters, 14, 1201-1203. https://doi.org/10.1016/j.bmcl.2003.12.047
[11]
Voilley, N. (2004) Acid-Sensing Ion Channels (ASICs): New Targets for the Analgesic Effects of Non-Steroid Anti-Inflammatory Drugs (NSAIDs). CurrentDrugTarget-Inflammation&Allergy, 3, 71-79. https://doi.org/10.2174/1568010043483980
[12]
Scheiman, J.M. (2016) NSAID-Induced Gastrointestinal Injury: A Focused Update for Clinicians. JournalofClinicalGastroenterology, 50, 5-10. https://doi.org/10.1097/mcg.0000000000000432
[13]
Scarpignato, C., Lanas, A., Blandizzi, C., Lems, W.F., Hermann, M. and Hunt, R.H. (2015) Safe Prescribing of Non-Steroidal Anti-Inflammatory Drugs in Patients with Osteoarthritis—An Expert Consensus Addressing Benefits as Well as Gastrointestinal and Cardiovascular Risks. BMCMedicine, 13, Article No. 55. https://doi.org/10.1186/s12916-015-0285-8
[14]
Kato, M., Sasaki, S., Sekimoto, Y., Arano, N., Jo, H., Suina, K., et al. (2016) Loxoprofen-induced Interstitial Pneumonia: A Case Report. JournalofMedicalCaseReports, 10, Article No. 128. https://doi.org/10.1186/s13256-016-0919-2
[15]
Nakase, H., Itani, T., Mimura, J., Kawasaki, T., Komori, H., Hashimoto, K., et al. (1999) Colonic Ulceration Caused by Administration of Loxoprofen Sodium. InternalMedicine, 38, 249-251. https://doi.org/10.2169/internalmedicine.38.249
[16]
Frishman, W.H. (2002) Effects of Nonsteroidal Anti-Inflammatory Drug Therapy on Blood Pressure and Peripheral Edema. TheAmericanJournalofCardiology, 89, 18-25. https://doi.org/10.1016/s0002-9149(02)02233-6
[17]
Robert, L., O’Bryant, C.L., Cheng, D., et al. (2016) Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement from the American Heart Association. Circulation, 134, e32-e69.
[18]
Sinnathamby, E.S., Urban, B.T., Clark, R.A., Roberts, L.T., De Witt, A.J., Wenger, D.M., et al. (2024) Etiology of Drug-Induced Edema: A Review of Dihydropyridine, Thiazolidinedione, and Other Medications Causing Edema. Cureus, 16, e53400. https://doi.org/10.7759/cureus.53400
[19]
Keast, D.H., Despatis, M., Allen, J.O. and Brassard, A. (2014) Chronic Oedema/Lymphoedema: Under-Recognised and Under-Treated. InternationalWoundJournal, 12, 328-333. https://doi.org/10.1111/iwj.12224