Medication Causes of Neutropenia

Aka: Medication Causes of Neutropenia, Neutropenia due to Medication, Drug-Induced Neutropenia, Drug-Induced Agranulocytosis

advertisement

II. Epidemiology

  1. Incidence 2.4 to 15.4 cases per 1 million adults/year

III. Pathophysiology

  1. Neutropenia is defined as ANC <1500/uL (<1000/uL in age <1 year)
  2. Drugs are second most common cause of Neutropenia
  3. Induce hypoproliferation via marrow injury

IV. Findings

  1. See Chemotherapy-Induced Neutropenia
  2. Idiosyncratic Drug-Induced Neutropenia
    1. Unrelated to direct Neutropenia causing agents (e.g. Chemotherapy, Biologic Agents)
    2. Neutropenia onset within 7 days of drug exposure
    3. Resolution is typical within 1 month of medication discontinuation
      1. Neutropenia often recurrs with accidental reexposure (not recommended)
  3. Exclude other causes
    1. Pancytopenia (associated Anemia or Thrombocytopenia)
    2. Recent infection (e.g. Mononucleosis, HIV Infection, Viral Hepatitis)
    3. Chronic Neutropenia Causes

V. Causes: Most common

  1. Chemotherapy-Induced Neutropenia
  2. Thyroid inhibitors (Antithyroid Drugs)
  3. Trimethoprim-Sulfamethoxazole (Septra, Bactrim)
  4. Sulfasalazine
  5. Clomipramine
  6. Dipyrone
  7. Concurrent Analgesic use is predisposing factor

VI. Causes: Chemotherapy-Induced Neutropenia (most common causes)

  1. See Chemotherapy-Induced Neutropenia
  2. See Alkylating Agents
  3. See Antimetabolite Chemotherapy
  4. Anthracyclines (e.g. Doxorubicin, Daunorubicin)
  5. Taxanes (e.g. Paclitaxel, Docetaxel)
  6. Topoisomerase Inhibitors (Etoposide)
  7. Platinum Chemotherapy (e.g. Cisplatin)
  8. Gemcitabine (Gemzar)
  9. Vinorelbine (Navelbine)

VII. Causes: Antimicrobials

  1. Penicillins and Cephalosporins (esp. Amoxicillin)
  2. Chloramphenicol
  3. Vancomycin
  4. Sulfonamide (trimethoprim-sulfamethoxazole)
  5. Gentamicin
  6. Clindamycin
  7. Doxycycline
  8. Minocycline
  9. Metronidazole
  10. Nitrofurantoin
  11. Rifampin
  12. Isoniazid
  13. Ethambutol
  14. Streptomycin
  15. Dapsone
  16. Ciprofloxacin
  17. Antimalarial medications (e.g. Chloroquine)
  18. Mebendazole
  19. Terbinafine
  20. Griseofulvin

VIII. Causes: Neuropsychotropics

  1. Antipsychotics
    1. Phenothiazine (e.g. Chlorpromazine)
    2. Risperidone (Risperdal)
    3. Clozapine (Clozaril)
    4. Haloperidol (Haldol)
    5. Olanzapine (Zyprexa)
    6. Quetiapine (Seroquel)
    7. Ziprasidone
    8. Thiothixene (Navane)
  2. Sedative-Hypnotics
    1. Barbiturates
    2. Meprobamate
  3. Antidepressants
    1. Imipramine or Desipramine
  4. Antiepileptics
    1. Valproic Acid (Depakote)
    2. Phenytoin (Dilantin)
    3. Carbamazepine (Tegretol)
    4. Ethosuximide (Zarontin)

IX. Causes: Cardiovascular Medications

  1. Antiarrhythmics
    1. Procainamide
    2. Quinidine
    3. Propafenone
    4. Amiodarone
    5. Digoxin
  2. Antihypertensives
    1. Lisinopril
    2. Ramipril
    3. Captopril
    4. Propranolol
    5. Hydralazine
    6. Methyldopa
    7. Furosemide
    8. Spironolactone
    9. Torsemide
    10. Thiazide Diuretics
    11. Propranolol
    12. Nifedipine
  3. Antiplatelet
    1. Clopidogrel
    2. Ticlopidine

X. Causes: Analgesics

  1. NSAIDs (Ibuprofen, Indomethacin, Sulindac, Tolmetin)
  2. Acetylsalicylic Acid (Aspirin)

XI. Causes: Miscellaneous

  1. Acetazolamide
  2. Allopurinol
  3. Colchicine
  4. Antithyroid Drugs (e.g. Propylthiouracil)
  5. Antihistamines (e.g. Cimetidine, Brompheniramine)
  6. Quinine
  7. Levodopa
  8. Heavy Metals
    1. Gold
    2. Arsenic
    3. Mercury

XII. Management

  1. Stop causative medications (and avoid reexposure)
  2. Hospitalization and broad spectrum Antibiotics for ANC <200/uL (Agranulocytosis)
  3. Follow weekly CBC until resolution

XIII. References

  1. Lee (1999) Wintrobe's Hematology, Lippincott, p. 1862-9
  2. Kim (2025) Am Fam Physician 112(6): 618-28 [PubMed]
  3. van der Klauw (1999) Arch Intern Med 159(4):369-74 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Medication Causes of Neutropenia." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Pharmacology

advertisement