Philippe Camus, M.D.

Dijon, France

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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.a

Pneumonitis (interstitial lung disease/ILD)
I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.d

Acute eosinophilic pneumonia (AEP)
I.e

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

ILD with a granulomatous component

XLI - Pulmonary edema - Acute lung injury - ARDS

XLI.a

Pulmonary edema, noncardiogenic (NCPE)
XLI.b

Pulmonary edema, cardiogenic
XLI.e

ARDS - Acute lung injury
XLI.k

Flash (fulminate) pulmonary edema

XLII - Pulmonary/alveolar./airway hemorrhage/bleeding

XLII.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

XLIII - Airway involvement

XLIII.a

Bronchospasm - Wheezing - Asthma
XLIII.b

Severe or catastrophic bronchospasm or asthma attack (can be fatal)
XLIII.j

Bronchiectasis

XLV - Pleural and/or pericardial involvement

XLV.f

Pneumothorax

XLVI - Pulmonary vasculopathy

XLVI.b

Pulmonary arterial hypertension
XLVI.g

Foreign body pulmonary vasculopathy (Excipient lung disease)

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

XLVIII.d

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

Respiratory arrest - Apnea
XLVIII.s

Botulism (foodborne-, wound-)
XLVIII.ad

Parsonage-Turner amyotrophic neuralgia-like syndrome

L - Miscellaneous

L.h

Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)
L.o

Death following exposure or poisoning

LI - Cardiovascular involvement / toxicity

LI.g

Cardiomyopathy (acute, subacute, chronic)
LI.n

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

LV - Imaging

LV.d

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

LVIII - Pathology

LVIII.d

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)
LVIII.t

Path: Pulmonary edema (see also II/IIa)
LVIII.ac

Path: Pneumoconiosis (silicosis, talcosis, talcoma)

LIX - Infections & related conditions

LIX.b

Opportunistic pulmonary/systemic infections

LXV - Veterinary medicine

LXV.e

Veterinary: Pulmonary edema