Common drugs that induce fever, by mechanism:
- Hypersensitivity – anticonvulsants, penicillin, minocycline, sulfonamide, allopurinol
- Altered thermoregulatory mechanisms – thyroxine, anticholinergics, amphetamines, cocaine
- Directly related to administration – paraldehyde, pentazocine, amphotericin B, bleomycin
- Direct extension of pharmacologic action – chemotherapy
- Idiosyncratic – succinylcholine, haloperidol, serotonergic
Risk of drug-induced fever increases with the number of medications taken, particularly in older adults and in those with active HIV infection. Patients with cystic fibrosis have a high incidence of drug-induced fever, most commonly from parenteral beta-lactams, piperacillin, and imipenem / cilastatin.
R50.2 – Drug induced fever
405543000 – Drug-induced hyperpyrexia (Drug fever)
- DRESS syndrome – Presents as diffuse morbilliform rash, atypical lymphocytosis, thrombocytopenia, eosinophilia, lymphadenopathy, and hepatitis; may reactivate herpes viruses; mortality is 5%-10%.
- Neuroleptic malignant syndrome – Presents as high fever (> 40ºC/104ºF), muscle rigidity, altered and fluctuating mental state, and dysautonomia in a patient taking antipsychotic drugs.
- Serotonin syndrome – Presents as hyperthermia, autonomic hyperactivity (diaphoresis, tachycardia), and neuromuscular disturbances (rigidity, hyperreflexia, clonus, tremors) in a patient taking serotonergic drugs.