Medication Causes of Neutropenia

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

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II. Pathophysiology

  1. Drugs are second most common cause of Neutropenia
  2. Induce hypoproliferation via marrow injury

III. Causes: Most common

  1. Chemotherapeutics (standard effect, see below)
  2. Thyroid inhibitors (Antithyroid Drugs)
  3. Trimethoprim-Sulfamethoxazole (Septra, Bactrim)
  4. Sulfasalazine
  5. Clomipramine
  6. Dipyrone
  7. Concurrent Analgesic use is predisposing factor

IV. Causes: Chemotherapeutics (most common causes)

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

V. Causes: Antibiotics

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

VI. Causes: Neuropsychotropics

  1. Phenothiazine (e.g. Chlorpromazine)
  2. Meprobamate
  3. Barbiturates
  4. Clozapine (Clozaril)
  5. Risperidone (Risperdal)
  6. Imipramine or Desipramine
  7. Thiothixene (Navane)
  8. Haloperidol (Haldol)
  9. Valproic Acid (Depakote)
  10. Phenytoin (Dilantin)
  11. Carbamazepine (Tegretol)
  12. Ethosuximide (Zarontin)

VII. Causes: Cardiovascular Medications

  1. Ticlopidine
  2. Antiarrhythmics
    1. Procainamide
    2. Quinidine
    3. Propafenone
  3. Antihypertensives
    1. Captopril
    2. Propranolol
    3. Hydralazine
    4. Methyldopa

VIII. Causes: Analgesics

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

IX. Causes: Miscellaneous

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

X. References

  1. Lee (1999) Wintrobe's Hematology, Lippincott, p. 1862-9
  2. van der Klauw (1999) Arch Intern Med 159(4):369-74 [PubMed]

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