Did You Know? Drug-Induced Photosensitivity
What causes Drug-Induced Photosensitivity?
Certain medications can cause sensitivity to the sun, known as photosensitivity, through two primary biological processes called phototoxicity (a chemically-induced reaction that may depend on the dose) and photoallergy (an immune-mediated reaction that is not related to dose).
The most effective way to address this issue is adequate sunlight protection. Patients who are prescribed the medications below should be advised to limit their exposure to sunlight by wearing protective clothing and using broad-spectrum sunscreens that protect against both UVA and UVB rays when sun exposure is unavoidable.
If a photosensitivity reaction develops, it is generally recommended to discontinue the offending drug; if stopping the medication is not possible, reducing the dose may help in certain cases, particularly with phototoxic reactions. Treatment may also include the use of topical or oral corticosteroids. It can take several weeks or even months for the skin reaction to resolve.
Medications Associated with Photosensitivity (Table)
The table below is not an all-inclusive list but a collection of commonly prescribed medications with a known correlation to photosensitivity reactions. Drugs that are stronger photosensitizers (higher risk) are highlighted in bold in the table.
| Drug Class | Drug Name | |
|---|---|---|
| Fluoroquinolones | • ciprofloxacin • levofloxacin • moxifloxacin | • nalidixic acid • ofloxacin |
| Tetracyclines | • demeclocycline • doxycycline | • tetracycline |
| Other Antibiotics | • ceftazidime • cefotaxime • dapsone • gentamicin • isoniazid | • nitrofurantoin • pyrazinamide • sulfamethoxazole • sulfisoxazole • trimethoprim |
| Antifungals | • griseofulvin • itraconazole • ketoconazole | • terbinafine • voriconazole |
| Antimalarials | • atovaquone/proguanil • chloroquine • hydroxychloroquine • mefloquine | • pyrimethamine • quinidine • quinine |
| Tricyclics | • amitriptyline • amoxapine • clomipramine • desipramine • doxepin | • imipramine • nortriptyline • protriptyline • trimipramine |
| SSRIs | • citalopram • escitalopram • fluoxetine | • fluvoxamine • paroxetine • sertraline |
| Other Antidepressants | • mirtazapine | • venlafaxine |
| Phenothiazines | • chlorpromazine • fluphenazine • olanzapine • perphenazine | • prochlorperazine • promethazine • thioridazine • trifluoperazine |
| Other antipsychotics | • aripiprazole • clozapine • haloperidol | • olanzapine • quetiapine • risperidone |
| Antihypertensives | • amlodipine • benazepril • captopril • diltiazem • enalapril • fosinopril • hydralazine | • lisinopril • methyldopa • nifedipine • olmesartan • quinapril • ramipril • valsartan |
| Antiplatelets | • clopidogrel | |
| Statins | • atorvastatin • pravastatin | • rosuvastatin • simvastatin |
| Other cardiovascular meds | • amiodarone • disopyramide • fenofibrate | • quinidine • sotalol |
| Diabetes medications | • canagliflozin • glimepiride • glipizide | • glyburide • metformin • sitagliptin |
| Thiazide diuretics | • chlorthalidone • chlorothiazide | • metolazone • hydrochlorothiazide |
| Other diuretics | • acetazolamide • amiloride • ethacrynic acid | • furosemide • spironolactone • triamterene |
| Hormonal medications | • ethinyl estradiol • corticosteroids | • progesterone |
| Immunosuppressants | • azathioprine • colchicine • omalizumab | • tacrolimus • toclizumab |
| Gastric | • esomeprazole • pantoprazole | • ranitidine |
| NSAIDs | • celecoxib • diclofenac • diflunisal • etodolac • indomethacin • ketoprofen | • mefenamic acid • nabumetone • naproxen • oxaprozin • piroxicam • sulindac |
| Retinoids, oral | • acitretin | • isotretinoin |
| Rheumatoid arthritis | • gold salts • leflunomide | • methotrexate • sulfasalazine |
| Sedatives | • alprazolam • chlordiazepoxide | • eszopiclone • zaleplon |
| Topical medications | • aminolevulinic acid • coal tar • fluorouracil | • methoxsalen • psoralens • tazarotene • tretinoin |
| Antiretrovirals | • daclatasvir • efavirenz | • tenofovir • ritonavir |
| Antihistamines | • cyproheptadine • brompheniramine • cetirizine | • diphenhydramine • loratadine • promethazine |
| Anticonvulsants | • carbamazepine • lamotrigine | • phenobarbital • phenytoin • valproic acid |
| Chemotherapy medications | • bicalutamide • capecitabine • crizotinib • dabrafenib • dacarbazine • epirubicin • fluorouracil • flutamide | • hydroxyurea • imatinib • paclitaxel • procarbazine • vandetanib • vemurafenib • vinblastine |
After-Sun Exposure Care
Managing a drug-induced photosensitivity reaction requires immediate UV avoidance, soothing damaged skin with cool compresses and gentle moisturizers, and using broad-spectrum mineral sunscreens that block UVA rays. Never stop prescribed medications without consulting your doctor.
Seek medical attention immediately if you develop severe blistering, fever, chills, nausea, or dizziness. Consult your healthcare providers to evaluate if the causative medication can be safely switched, adjusted, or timed differently (such as taking it at night).
References:
- Clinical Resource, Drug-Induced Photosensitivity. Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber’s Letter. May 2023. [390509]
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