Many drugs are responsible, through different mechanisms, for peripheral
edema. Severity is highly variable ranging from slight edema of the
lower limbs to anasarca pictures as in the capillary leak syndrome.
Although most often non-inflammatory and bilateral, some drugs are
associated with peripheral edema that is readily erythematous (e.g.,
dopaminergic agonists, pemetrexed) or unilateral (e.g., sirolimus).
Thus, drug-induced peripheral edema is underrecognized and misdiagnosed,
frequently leading to a prescribing cascade. Four main mechanisms are
involved, namely precapillary arteriolar vasodilation (vasodilatory
edema), sodium/water retention (renal edema), lymphatic insufficiency
(lymphedema) and increased capillary permeability (permeability edema).
The underlying mechanism has significant impact on treatment efficacy.
This review provides a comprehensive analysis of the main causative
drugs by illustrating each pathophysiological mechanism and their
management through an example of drug.