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)
