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The Drug-Induced Respiratory Disease Website and App

Heroin (intravenous)

Ventilatory depression / respiratory arrest amenable to resuscitation measures and the specific antidote naloxone (PMID 26370638) is the most common complication of the substance. Acute, flash pulmonary edema is a classic complication of i.v. heroin. Benzodiazepine and alcohol (ethanol) may be cotoxicants in heroin-associated deaths (PMID 2391481). The development of PAH should raise the suspicion of pill excipient-induced vasculopathy and consequent PHT. Buprenorphine diversion may lead to that complication. Major contribution at PMID 5339228

Frequency - Incidence

Incidence of respiratory 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 respiratory 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

I - Interstitial/parenchymal lung disease

I.b

Pneumonitis (interstitial lung disease/ILD)
I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.d

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
I.e

Acute eosinophilic pneumonia (AEP)
I.m

ILD with a granulomatous component

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)
II.b

ARDS - Acute lung injury
II.d

Pulmonary edema, cardiogenic
II.i

Flash (fulminate) pulmonary edema

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma
IV.f

Severe or catastrophic bronchospasm or asthma attack (can be fatal)
IV.k

Bronchiectasis

V - Pleural and/or pericardial involvement

V.f

Pneumothorax

VI - Pulmonary vasculopathy

VI.b

Pulmonary arterial hypertension
VI.g

Foreign body pulmonary vasculopathy (Excipient lung disease)

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.d

Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)
IX.i

Respiratory arrest - Apnea
IX.s

Botulism (foodborne-, wound-)
IX.ad

Parsonage-Turner amyotrophic neuralgia-like syndrome

XI - Miscellaneous

XI.g

Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)
XI.r

Death following exposure or poisoning

XII - Cardiovascular involvement / toxicity

XII.f

Cardiomyopathy (acute, subacute, chronic)
XII.l

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

XV - Pathology

XV.c

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)
XV.s

Path: Pneumoconiosis (silicosis, talcosis, talcoma)
XV.w

Path: Pulmonary edema (see also II/IIa)

XVI - Imaging

XVI.d

Imaging: Alveolar opacities or haze with a batwing or butterfly distribution

XVII - Infections & related conditions

XVII.b

Opportunistic pulmonary/systemic infections

XXIV - Veterinary medicine

XXIV.c

Veterinary: Pulmonary edema