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The Drug-Induced Cardiotoxicity Website and App

Trimethoprim sulfamethoxazole (TMP-SMX)

Specialities: Diagnostic radiology · Infectious diseases · Intensive care medicine · Internal medicine · Orthopedic surgery · Pathology · Pulmonary medicine

An antibiotic widely use to prevent Pneumocystis pneumonia from developing. The drug is also used to treat acne in young persons. The major adverse effect is an ARDS picture leading to life-threatening poorly reversible lung damage requiring lung transplantation in a sizeable fraction of the patients.

Frequency - Incidence

Incidence of cardiac adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for cardiac adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

X - Pulmonary edema - ALI/ARDS

X.b

Pulmonary edema, noncardiogenic (NCPE)

XIV - Pleural involvement

XIV.f

Pneumothorax

XXI - Mediastinal involvement/injury

XXI.c

Pneumomediastinum

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

ARDS - Acute lung injury
XXII.c

Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

XXIII - Hemoglobinopathies (acquired, reversible)

XXIII.a

Methemoglobinemia

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (interstitial lung disease/ILD)
XXIV.b

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)
XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
XXIV.d

Acute eosinophilic pneumonia (AEP)
XXIV.m

Acute fibrinous organizing pneumonia (AFOP)
XXIV.al

Irreversible respiratory damage requiring lung Tx

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.a

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)
XXXVI.e

ANCA positivity. Subclinical or with clinical manifestations
XXXVI.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)
XXXVI.m

DRES syndrome - DRESS-like reaction

XXXVIII - Miscellaneous - Varia

XXXVIII.k

Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)