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Maciá-Martínez MÁ, Castillo-Cano B, García-Poza P, Martín-Merino E. Risk of agranulocytosis with metamizole in comparison with alternative medications based on health records in Spain. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03706-5. [PMID: 38907883 DOI: 10.1007/s00228-024-03706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/28/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE We aimed to estimate the absolute (incidence) and relative (hazard ratio; HR) risk of agranulocytosis associated with metamizole in comparison with non-steroidal antiinflammatory drugs (NSAIDs). METHODS A cohort study of new users of metamizole versus NSAIDs was performed with BIFAP (Pharmacoepidemiologic Research Database in Public Health Systems; Spain). Patients aged ≥ 2 years in 2005-2022 were followed up from the day after their first metamizole or NSAID dispensation till the end of the treatment period to identify patients hospitalized due to idiosyncratic agranulocytosis. Incidence rate (IR) and adjusted HR of agranulocytosis with metamizole versus NSAID were estimated assuming the onset date of agranulocytosis was the date of hospitalization sensitivity analysis or 7 days before (main analysis). In secondary analyses, we used (1) opioids-paracetamol as negative control and (2) any hospitalized neutropenia as outcome (assuming the onset was 7 days before). RESULTS The cohorts included 444,972 new users of metamizole, 3,814,367 NSAID, and 3,129,221 opioids-paracetamol on continuous treatment during a median of 37-40 days. Overall, 26 hospitalized agranulocytosis occurred, 5 in the first week (and so removed in main analysis) and 21 thereafter. IR of agranulocytosis was 14.20 (N = 5 cases) and 8.52 (N = 3), 1.95 (N = 6) and 1.62 (N = 5), and 4.29 (N = 15) and 3.72 (N = 13)/107 person-weeks of continuous treatment using the date of hospitalization or 7 days before, respectively. Two, 0 and 2 of cases identified in both analyses had neoplasia in every cohort, respectively. HR of agranulocytosis associated with metamizole was 7.20 [95% CI: 1.92-26.99] and 4.40 [0.90-21.57] versus NSAID, and 3.31 [1.17-9.34] and 2.45 [0.68-8.83] versus opioid-paracetamol, respectively. HR of neutropenia with metamizole was 2.98 [1.57-5.65] versus NSAID. CONCLUSIONS Agranulocytosis was very rare but more common (above 4 times more) with metamizole than other analgesics. The impact of the drug-induced agranulocytosis was less precise with metamizole than the comparators due to its lower use, which precluded to find statistical differences in main analysis. The increased risk of hospitalized neutropenias with metamizole supports the link with its severity although triggers unavailable during the follow-up (ex. cytotoxic medication) can not be discarded.
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Affiliation(s)
| | - Belén Castillo-Cano
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | | | - Elisa Martín-Merino
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
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Eleutério OHP, Veronezi RN, Martinez-Sobalvarro JV, Marrafon DAFDO, Eleutério LP, Rascado RR, Dos Reis TM, Podestá MHMC, Torres LH. Safety of metamizole (dipyrone) for the treatment of mild to moderate pain-an overview of systematic reviews. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03240-2. [PMID: 38888755 DOI: 10.1007/s00210-024-03240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Metamizole, as known as dipyrone or novaminsulfone is widely used, especially in Latin America, for its analgesic and antipyretic function. However, several countries have banned it due to the risk of agranulocytosis, skin necrosis, and other serious adverse effects. To assess the safety of metamizole compared to other commonly used non-opioid analgesics (paracetamol, ibuprofen, and acetylsalicylic acid). An overview of systematic reviews. The searches were performed in the PubMed, Cochrane Library, Embase, Scopus and LILACS databases. Systematic reviews of randomized and nonrandomized clinical trials with adult patients with mild to moderate pain that assessed the adverse effects of metamizole were included. A methodological quality assessment was performed through ROBIS. The protocol of this systematic review was submitted to the International Prospective Register of Systematic Reviews (Prospero, CRD42021295272). Of 387 identified studies, four were included, with a total of 20,643 participants, all submitted to a single dose by oral, intramuscular, or intravenous route. No study reported a serious adverse effect. However, 60 of 778 patients (7.7%) who used metamizole; 120/828 (14.5%) who used acetylsalicylic acid; 56/443 (12.6%) who used paracetamol; and 27/213 (12.7%) who used ibuprofen had mild adverse effects. A complementary statistical analysis showed that metamizole, at any dose, has a 38.8% lower chance of adverse effects compared to paracetamol and 46.8% compared to acetylsalicylic acid. The results shows that metamizole is a safe drug with evidence of a lower incidence of adverse effects compared to paracetamol and acetylsalicylic acid.
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Affiliation(s)
- Otávio Henrique Porto Eleutério
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
- School of Medicine, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil
| | - Rafael Nakano Veronezi
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
- School of Medicine, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil
| | - Joselin Valeska Martinez-Sobalvarro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
- Department of Pharmacy, Health Sciences Sector, Federal University of Paraná, Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil
| | | | - Larissa Porto Eleutério
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Rua Sérgio Buarque de Holanda, 651, Campinas, SP, 13083-859, Brazil
| | - Ricardo Radighieri Rascado
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
| | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil
| | - Márcia Helena Miranda Cardoso Podestá
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil.
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Shale WT, Umer KM, Tola GG, Guluju FA. Asymptomatic Propylthiouracil Induced Agranulocytosis in a Patient with Toxic Nodular Goiter: A Rare Case Report. Int Med Case Rep J 2023; 16:503-512. [PMID: 37701536 PMCID: PMC10493100 DOI: 10.2147/imcrj.s424053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Background Agranulocytosis is a rare but fatal side effect of antithyroid drugs (ATDs) with incidence reported at 0.1%-1%. Agranulocytosis is defined as a granulocyte count <500 cells/μL following the use of ATDs and is an absolute contraindication to the use of these drugs; in this case, radioactive iodine (RAI) or surgery are therapeutic options. Case Presentation A 28-year-old female patient was on follow-up at our clinic after she presented with anterior neck swelling of 4 years. The patient was started on propylthiouracil (PTU) and propranolol based on clinical symptoms of hyperthyroidism and low thyroid stimulating hormone (TSH) levels. After taking the ATDs for 7 months, she came to the clinic for her regular follow-up. At this point, she was declared euthyroid and booked for surgery. Investigations were sent and the complete blood count (CBC) result showed leucopenia with agranulocytosis, even though she was completely asymptomatic. The offending ATD was immediately discontinued. The patient was kept inpatient for monitoring, and lugol's iodine and propranolol were initiated. Eight days after discontinuing the ATD, the CBC profile was determined once again, showing normalized total leukocyte, as well as, absolute neutrophil count. Eventually, the multinodular goiter (MNG) was managed with subtotal thyroidectomy. Conclusion Despite the fact that agranulocytosis is an extremely rare side effect of ATDs, most often PTU; it is a potentially fatal complication when it occurs. Patient education at the time of prescription should not be overlooked, and systematic programs should be put in place. The baseline granulocyte count should be determined and monitored on a regular basis.
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Affiliation(s)
- Wongel Tena Shale
- Jimma University, College of Public Health and Medical Sciences, Department of Surgery, Jimma, Oromia, Ethiopia
| | - Keno Mohammed Umer
- Department of General Surgery, Dire Dawa University, Dire Dawa, Ethiopia
| | - Gutu Ganati Tola
- Jimma University, College of Public Health and Medical Sciences, Department of Surgery, Jimma, Oromia, Ethiopia
| | - Fayera Abetu Guluju
- Jimma University, College of Public Health and Medical Sciences, Department of Surgery, Jimma, Oromia, Ethiopia
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Saito T, Usui T, Inada H, Miyawaki I, Mizuno K, Ikeda M, Iwata N. Clozapine-specific proliferative response of peripheral blood-derived mononuclear cells in Japanese patients with clozapine-induced agranulocytosis. J Psychopharmacol 2022; 36:1087-1094. [PMID: 35861221 DOI: 10.1177/02698811221112937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although clozapine-induced granulocytopenia (CIG) is less severe than clozapine-induced agranulocytosis (CIA), and some patients with CIG may not go on to develop serious complications, clozapine is discontinued in cases of both CIA and CIG. Understanding the pathogenic mechanisms of CIA/CIG could provide better management of clozapine therapy. Recently, as a mechanistic insight into adaptive immune systems, European groups reported clozapine-specific proliferative responses and clozapine-specific T cells using blood taken from patients with CIA and/or CIG. AIMS The aims of our study are to support this mechanistic evidence and to investigate the difference in the lymphocyte response to clozapine between patients with CIG and those with CIA. METHODS Lymphocyte stimulation tests (LSTs) were conducted using CD25-positive cell-depleted peripheral blood-derived mononuclear cells (PBMCs) isolated from blood of four Japanese patients with CIA, four patients with CIG, and nine clozapine-tolerant subjects. RESULTS Three of four patients with CIA and one of four patients with CIG showed proliferative responses to clozapine with a stimulation index of greater than 2. In contrast, none of the nine clozapine-tolerant subjects showed any response to clozapine. Olanzapine did not stimulate PBMCs of patients with CIA, patients with CIG, or clozapine-tolerant subjects. CONCLUSIONS Clozapine- and CIA-specific lymphocyte reactions in a Japanese population provided supportive evidence that the pathogenesis of CIA is based on adaptive immune reactions. In addition, patients with CIG who show a positive response to an LST may at the very least not be chosen for clozapine-rechallenge and further prospective studies are desirable to verify this hypothesis.
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Affiliation(s)
- Takeo Saito
- Department of Psychiatry, School of Medicine, Fujita Health University, Aichi, Japan
| | - Toru Usui
- Preclinical Research Unit, Sumitomo Pharma Co., Ltd., Osaka, Japan
| | - Hiroshi Inada
- Preclinical Research Unit, Sumitomo Pharma Co., Ltd., Osaka, Japan
| | - Izuru Miyawaki
- Preclinical Research Unit, Sumitomo Pharma Co., Ltd., Osaka, Japan
| | | | - Masashi Ikeda
- Department of Psychiatry, School of Medicine, Fujita Health University, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, School of Medicine, Fujita Health University, Aichi, Japan
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Rattay B, Benndorf RA. Drug-Induced Idiosyncratic Agranulocytosis - Infrequent but Dangerous. Front Pharmacol 2021; 12:727717. [PMID: 34483939 PMCID: PMC8414253 DOI: 10.3389/fphar.2021.727717] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022] Open
Abstract
Drug-induced agranulocytosis is a life-threatening side effect that usually manifests as a severe form of neutropenia associated with fever or signs of sepsis. It can occur as a problem in the context of therapy with a wide variety of drug classes. Numerous drugs are capable of triggering the rare idiosyncratic form of agranulocytosis, which, unlike agranulocytosis induced by cytotoxic drugs in cancer chemotherapy, is characterised by “bizzare” type B or hypersensitivity reactions, poor predictability and a mainly low incidence. The idiosyncratic reactions are thought to be initiated by chemically reactive drugs or reactive metabolites that react with proteins and may subsequently elicit an immune response, particularly directed against neutrophils and their precursors. Cells or organs that exhibit specific metabolic and biotransformation activity are therefore frequently affected. In this review, we provide an update on the understanding of drug-induced idiosyncratic agranulocytosis. Using important triggering drugs as examples, we will summarise and discuss the chemical, the biotransformation-related, the mechanistic and the therapeutic basis of this clinically relevant and undesirable side effect.
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Affiliation(s)
- Bernd Rattay
- Department of Clinical Pharmacy and Pharmacotherapy, Institute of Pharmacy, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralf A Benndorf
- Department of Clinical Pharmacy and Pharmacotherapy, Institute of Pharmacy, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Lapostolle A, Delion T, Arnaud S, Manceau P, Degos B. Thrombocytopenia and agranulocytosis in a FXTAS choreic patient treated with tetrabenazine. Neurol Sci 2021; 42:3475-3477. [PMID: 33970378 DOI: 10.1007/s10072-021-05310-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Arnaud Lapostolle
- Service de Neurologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris, Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
| | - Timo Delion
- Service de Neurologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris, Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
| | - Souraya Arnaud
- Service de Neurologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris, Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
| | - Philippe Manceau
- Service de Neurologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris, Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
| | - Bertrand Degos
- Service de Neurologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris, Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France. .,Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, 75005, Paris, France.
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Ramsbottom KA, Carr DF, Rigden DJ, Jones AR. Informatics investigations into anti-thyroid drug induced agranulocytosis associated with multiple HLA-B alleles. PLoS One 2020; 15:e0220754. [PMID: 32027661 PMCID: PMC7004376 DOI: 10.1371/journal.pone.0220754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/22/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Adverse drug reactions have been linked with HLA alleles in different studies. These HLA proteins play an essential role in the adaptive immune response for the presentation of self and non-self peptides. Anti-thyroid drugs methimazole and propylthiouracil have been associated with drug induced agranulocytosis (severe lower white blood cell count) in patients with B*27:05, B*38:02 and DRB1*08:03 alleles in different populations: Taiwanese, Vietnamese, Han Chinese and Caucasian. METHODS In this study, informatics methods were used to investigate if any sequence or structural similarities exist between the two associated HLA-B alleles, compared with a set of "control" alleles assumed not be associated, which could help explain the molecular basis of the adverse drug reaction. We demonstrated using MHC Motif Viewer and MHCcluster that the two alleles do not have a propensity to bind similar peptides, and thus at a gross level the structure of the antigen presentation region of the two alleles are not similar. We also performed multiple sequence alignment to identify polymorphisms shared by the risk but not by the control alleles and molecular docking to compare the predicted binding poses of the drug-allele combinations. RESULTS Two residues, Cys67 and Thr80, were identified from the multiple sequence alignments to be unique to these risk alleles alone. The molecular docking showed the poses of the risk alleles to favour the F-pocket of the peptide binding groove, close to the Thr80 residue, with the control alleles generally favouring a different pocket. The data are thus suggestive that Thr80 may be a critical residue in HLA-mediated anti-thyroid drug induced agranulocytosis, and thus can guide future research and risk assessment.
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Affiliation(s)
- Kerry A. Ramsbottom
- Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Daniel F. Carr
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Daniel J. Rigden
- Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Andrew R. Jones
- Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
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Jayaweera JAAS, Abeydeera WPH, Ranasinghe GR. Intravenously administered cloxacillin-induced neutropenia with eosinophilia in a patient with infective endocarditis: a case report. J Med Case Rep 2018; 12:384. [PMID: 30593283 PMCID: PMC6310943 DOI: 10.1186/s13256-018-1933-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background Bacteremia following Staphylococcus aureus is a serious clinical condition which is often associated with distant metastatic infections. One of the most dreaded complications of Staphylococcus aureus bacteremia is infective endocarditis. Cloxacillin is a common antibiotic prescribed for suspected staphylococcal infections and confirmed methicillin-sensitive Staphylococcus aureus infections. Prolonged use of cloxacillin may lead to neutropenia. Case presentation A 38-year-old Sinhalese man presented to Teaching Hospital Kurunegala, Sri Lanka, complaining of a 3-week history of fever; he was found to have a pansystolic murmur over the apex of his heart. He had leukocytosis with predominant neutrocytosis. His C-reactive protein was 231 mg/l and erythrocyte sedimentation rate was 100 mm/first hour. Transthoracic two-dimensional echocardiography revealed prolapsed mitral valve with 7 × 13 mm vegetation over the posterior mitral valve. On the following day, three blood cultures became positive and were subsequently identified as Staphylococcus aureus. Intravenously administered cloxacillin 3 g 6 hourly was started. Following day 24 of intravenously administered cloxacillin, our patient developed high spike fever. His total white blood cells were: 990/mm3 with 34% neutrophils and 22% eosinophils. His hemoglobin concentration was 9.5 g/dL and platelet count remained normal (202 × 106/mm3). His C-reactive protein was 78 mg/l, erythrocyte sedimentation rate was 95 mm/first hour, and he was otherwise comfortable, showing no signs of sepsis beside the high grade fever. His serum was negative for filarial and Toxoplasma antibodies while stool was negative for oocytes and amoebic cysts. Further, his serum was negative for dengue virus, Epstein–Barr virus, cytomegalovirus, and hepatitis B antibodies. He was clinically well on day 6 after stopping cloxacillin with 44% neutrophils and 18% eosinophils. His C-reactive protein and erythrocyte sedimentation rate became normal, and there was no further plan for cardiothoracic intervention or administration of antimicrobials. He was discharged from hospital and remained well 6 months later. Conclusion This case report signifies the potential fatal adverse effect of cloxacillin in methicillin-sensitive Staphylococcus aureus infections. Leukopenia is associated with prolonged use of high doses of cloxacillin. In addition to transthoracic two-dimensional echocardiography and inflammatory markers, sequential white blood cells and differential counts would help clinicians to assess the prognosis of patients with infective endocarditis.
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Affiliation(s)
- J A A S Jayaweera
- Department of Microbiology Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. .,Teaching Hospital Kurunegala, Kurunegala, Sri Lanka.
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de Souza EC, Matos DM, Viana MR, Alvim MCO, Bonfante HL, Pinto AF, Nascimento JWL. Evaluation of hematological alterations after therapeutic use of dipyrone in healthy adults: a prospective study. J Basic Clin Physiol Pharmacol 2018; 29:385-390. [PMID: 29432206 DOI: 10.1515/jbcpp-2017-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022]
Abstract
Background Dipyrone is a non-narcotic analgesic/antipyretic widely used in some countries but prohibited in others due to suspected risk of agranulocytosis. The primary goal of this study was to evaluate hematological alterations in healthy adult volunteers after treatment with dipyrone. Methods The study enrolled 30 healthy volunteers of both genders, aged 19-37 years. They received tablets containing 500 mg of dipyrone sodium to be used four times daily for 7 consecutive days. Before the first administration, arterial pressure was measured and blood was collected in order to evaluate hematological baseline parameters. On the 8th day after the beginning of treatment, the volunteers had their blood pressure assessed once more and underwent a second blood draw. Total and specific leukocyte counts, creatinine, urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), erythrocytes, and platelets were quantitatively determined. Results No statistically significant difference was observed among total or specific leukocyte counts. Number of platelets, erythrocytes, hemoglobin, and hematocrit decreased after treatment. Diastolic pressure, mean arterial pressure (MAP), and urea concentration declined, while creatinine, AST, and ALT showed no significant alterations. It is noteworthy that, even for parameters that showed statistically significant changes, the highest and lowest values remained within the normal ranges. Conclusions Although dipyrone has historically been associated with agranulocytosis, leukocyte counts remained practically unchanged after oral administration of dipyrone. On the other hand, the present study adds evidence that dipyrone is able to produce statistically relevant decrease in number of platelets, erythrocytes, hemoglobin, and hematocrit in healthy adults, even after short-term treatment.
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Affiliation(s)
- Ernane C de Souza
- University of Iowa College of Pharmacy, Division of Medicinal and Natural Products Chemistry, Iowa City, IA, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Dalyara M Matos
- Post graduation Program in Pharmaceutical Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Milainy R Viana
- Department of Pharmaceutical Sciences, College of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Marcela C O Alvim
- Department of Pharmaceutical Sciences, College of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Herval L Bonfante
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Alexandre F Pinto
- Department of Pharmaceutical Sciences, College of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Jorge W L Nascimento
- Universidade Federal de Juiz de Fora, Instituto de Ciências Biológicas, Laboratório de Farmacologia Clínica e Experimental (LaFaCE), Departamento de Farmacologia, Rua José Lourenço Kelmer, s/n. 36036-900, Juiz de Fora, MG, Brasil, Phone: +55 32 2102-3369; 55 32 2102-3210, Fax: +55 32 2102-3216.,Post graduation Program in Pharmaceutical Sciences, Federal University of Juiz de Fora, 36036-900, Juiz de Fora, MG, Brazil
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Hongo T, Nozaki S, Tsuchiya M, Inaba M, Takahashi K, Fujiwara T. Contrast medium-induced transient severe leukopenia. Acute Med Surg 2018; 5:185-188. [PMID: 29657733 PMCID: PMC5891103 DOI: 10.1002/ams2.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/21/2017] [Indexed: 11/07/2022] Open
Abstract
Case Contrast medium-induced transient leukopenia is very rare. Here, we report a case of a 73-year-old man diagnosed with contrast media-induced transient leukopenia. The patient underwent abdominal contrast-enhanced computed tomography, where he was given non-ionic iodinated contrast medium i.v. His medical history included an allergic reaction to a different contrast medium. One hour later, the patient was admitted to the emergency department complaining of chest discomfort. He had leukopenia and a fever (temperature of 38.9°C). Complete blood count showed a white blood cell count of 930/μL and an absolute neutrophilic count of 232/μL. Outcome The patient was given i.v. antibiotics and 5 mg chlorpheniramine maleic acid, 20 mg famotidine, and 125 mg methylprednisolone. The patient's white blood cell count recovered the next day, and he was discharged after 2 days of hospitalization. Conclusion We diagnosed the patient with contrast media-induced transient leukopenia, which is a rare phenomenon.
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Affiliation(s)
- Takashi Hongo
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Satoshi Nozaki
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Midori Tsuchiya
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Mototaka Inaba
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Kenji Takahashi
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
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Fasullo S, Davì S, Cosenza G, Di Franco F, La Manna N, Giubilato A, Vetrano G, Maringhini G. Acute agranulocytosis after oral administration of dabigatran: a rare case report and a short review of literature. J Thromb Thrombolysis 2018; 45:588-592. [DOI: 10.1007/s11239-018-1624-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chen J, Zhong B, Wang Y. Agranulocytosis Induced by Sinomenine Hydrochloride. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:959-962. [PMID: 28874654 PMCID: PMC5597034 DOI: 10.12659/ajcr.904519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patient: Female, 44 Final Diagnosis: Agranulocytosis Symptoms: Fever • pharyngalgia Medication: Sinomenine Clinical Procedure: Stop taking medicine and treat it Specialty: Rheumatology
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Affiliation(s)
- Juerong Chen
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Bing Zhong
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Yong Wang
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
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13
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Vicente N, Cardoso L, Barros L, Carrilho F. Antithyroid Drug-Induced Agranulocytosis: State of the Art on Diagnosis and Management. Drugs R D 2017; 17:91-96. [PMID: 28105610 PMCID: PMC5318340 DOI: 10.1007/s40268-017-0172-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Agranulocytosis is a rare but serious complication of antithyroid drug therapy, and an up-to-date understanding of this topic is important. Both direct toxicity and immune-mediated responses have been described as possible mechanisms. Some major susceptibility loci have recently been identified, which may lead the diagnosis of agranulocytosis into a genomic era. Onset is acute and patients present with symptoms and signs of infection together with high fever. Clinical suspicion is pivotal and should prompt blood sampling. An absolute neutrophil count of <500/μl in the presence of antithyroid drugs establishes the diagnosis. The causative drug should immediately be stopped to prevent further damage. Treatment includes broad-spectrum antibiotics and granulocyte-colony stimulation factor in selected patients. Later, patients will need definitive treatment for hyperthyroidism, usually with radioactive iodine or surgery. The best way to avoid the mortality associated with antithyroid drug-induced agranulocytosis is patient education.
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Affiliation(s)
- Nuno Vicente
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Luís Cardoso
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Luísa Barros
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
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14
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Peng RR, Wu J, Zhao W, Qi T, Shi M, Guan Z, Lu H, Long F, Gao Z, Zhang S, Zhou P. Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter? PLoS Negl Trop Dis 2017; 11:e0005456. [PMID: 28288165 PMCID: PMC5363990 DOI: 10.1371/journal.pntd.0005456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/23/2017] [Accepted: 03/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Prompt therapy with high-dose intravenous benzylpenicillin for a prolonged period is critical for neurosyphilis patients to avoid irreversible sequelae. However, life-threatening neutropenia has been reported as a complication of prolonged therapy with high doses of benzylpenicillin when treating other diseases. This study aimed to investigate the incidence, presentation, management and prognosis of benzylpenicillin-induced neutropenia in treating neurosyphilis based on a large sample of syphilis patients in Shanghai. METHODOLOGY/PRINCIPAL FINDINGS Between 1st January 2013 and 31st December 2015, 1367 patients with neurosyphilis were treated with benzylpenicillin, 578 of whom were eligible for recruitment to this study. Among patients without medical co-morbidities, the total incidence of benzylpenicillin-induced neutropenia and severe neutropenia was 2.42% (95% CI: 1.38-4.13%) and 0.35% (95% CI: 0.06-1.39%), respectively. The treatment duration before onset of neutropenia ranged from 10 to 14 days, with a total cumulative dose of between 240 and 324 megaunits of benzylpenicillin. Neutropenia was accompanied by symptoms of chills and fever (5 patients), fatigue (2 patients), cough (1 patient), sore throat (1 patient), diarrhea (1 patient) and erythematous rash (1 patient). The severity of neutropenia was not associated with age, gender or type of neurosyphilis (p>0.05). Neutropenia, even when severe, was often tolerated and normalized within one week. A more serious neutropenia did not occur when reinstituting benzylpenicillin in patients with mild or moderate neutropenia nor when ceftriaxone was used three months after patients had previously experienced severe neutropenia. CONCLUSIONS/SIGNIFICANCE Benzylpenicillin-induced neutropenia was uncommon in our cohort of patients. Continuation of therapy was possible with intensive surveillance for those with mild or moderate neutropenia. For severe neutropenia, it is not essential to aggressively use hematopoietic growth factors or broad-spectrum antibiotics for patients in good physical condition after withdrawing anti-neurosyphilis regimen. We did not see an exacerbation of neutropenia in patients with the readministration of benzylpenicillin.
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Affiliation(s)
- Rui-Rui Peng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Wei Zhao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Tengfei Qi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Mei Shi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zhifang Guan
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Haikong Lu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Fuquan Long
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zixiao Gao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Sufang Zhang
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Pingyu Zhou
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
- * E-mail:
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15
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Sing CW, Wong ICK, Cheung BMY, Chan JCY, Chu JKP, Cheung CL. Incidence and risk estimate of drug-induced agranulocytosis in Hong Kong Chinese. A population-based case-control study. Pharmacoepidemiol Drug Saf 2017; 26:248-255. [DOI: 10.1002/pds.4156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Chor-Wing Sing
- Department of Pharmacology and Pharmacy; The University of Hong Kong; Hong Kong
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy; The University of Hong Kong; Hong Kong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, School of Pharmacy; University College London; London UK
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong
| | - Bernard M. Y. Cheung
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong
- Department of Medicine; The University of Hong Kong; Hong Kong
| | | | - Jody K. P. Chu
- Department of Pharmacology and Pharmacy; The University of Hong Kong; Hong Kong
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy; The University of Hong Kong; Hong Kong
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong
- Department of Medicine; The University of Hong Kong; Hong Kong
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16
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Hashmi HRT, Jabbour R, Schreiber Z, Khaja M. Benazepril-Induced Agranulocytosis: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:425-8. [PMID: 27335175 PMCID: PMC4920103 DOI: 10.12659/ajcr.898028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient: Male, 61 Final Diagnosis: Benazepril induced agranulocytosis Symptoms: Sepsis Medication: — Clinical Procedure: None Specialty: Critical Care Medicine
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Affiliation(s)
| | - Rami Jabbour
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Zwi Schreiber
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
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17
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Koutsavlis I, Lasebai M. Dose-Dependent Carbamazepine-Induced Agranulocytosis Following Bariatric Surgery (Sleeve Gastrectomy): A Possible Mechanism. Bariatr Surg Pract Patient Care 2015. [DOI: 10.1089/bari.2015.0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
| | - Muayed Lasebai
- Department of Haematology, NHS Lothian, Edinburgh, United Kingdom
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18
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Johnston A, Uetrecht J. Current understanding of the mechanisms of idiosyncratic drug-induced agranulocytosis. Expert Opin Drug Metab Toxicol 2014; 11:243-57. [DOI: 10.1517/17425255.2015.985649] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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19
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Pick AM, Nystrom KK. Nonchemotherapy drug-induced neutropenia and agranulocytosis: could medications be the culprit? J Pharm Pract 2014; 27:447-52. [PMID: 25124379 DOI: 10.1177/0897190014546115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Drug-induced agranulocytosis is a severe complication that has been implicated with most classes of medications. Medications such as clozapine, trimethoprim-sulfamethoxazole and methimazole have been more commonly associated with agranulocytosis than other agents. Although the pathogenesis isn't fully elucidated, it appears to be two-fold with a direct toxicity to the myeloid cell line and immune-mediated destruction. Patients may be asymptomatic at the time neutropenia is discovered or may present with more severe complications such as sepsis. In approximately 5% of cases drug-induced agranulocytosis may be fatal. Management of drug-induced agranulocytosis includes the immediate discontinuation of the offending medication, initiation of broad-spectrum antibiotics and consideration of the use of granulocyte colony-stimulating factors in high-risk patients.
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Affiliation(s)
- Amy M Pick
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, NE, USA
| | - Kelly K Nystrom
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, NE, USA
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20
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Azadeh N, Kelemen K, Fonseca R. Amitriptyline-induced agranulocytosis with bone marrow confirmation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e183-5. [PMID: 25052053 DOI: 10.1016/j.clml.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/09/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Natalya Azadeh
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Katalin Kelemen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - Rafael Fonseca
- Division of Hematology and Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ.
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21
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Nair B, MacCabe JH. Making clozapine safer: current perspectives on improving its tolerability. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
ABSTRACT: Clozapine is the gold standard treatment for refractory schizophrenia and its benefits are supported by an evidence base. Yet, it remains largely underused in clinical practice. This is because of low acceptability from patients and reluctance in initiating, and delays in prescribing by clinicians. A major deterrent is often the common adverse reactions, which clinicians are apt to disregard, focusing instead on the severe but rare complications of clozapine, such as agranulocytosis. We will review recent evidence on increasing the prescription of clozapine, focusing particularly on improving the safety and tolerability of the drug, by effective management of its adverse effects. The adverse effects considered in our review include sedation, seizures, myoclonus, hypersalivation, nausea, constipation, hypotension, hypertension, tachycardia, myocarditis, cardiomyopathy, weight gain, diabetes, dyslipidemia, neutropenia, agranulocytosis, fever, nocturnal enuresis and obsessive–compulsive symptoms. We will also discuss strategies to enable successful clozapine rechallenge after severe cardiac and hematological adverse reactions, thus aiming to offer patients their best chance at recovery.
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Affiliation(s)
- Bosky Nair
- National Psychosis Unit, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - James Hunter MacCabe
- Institute of Psychiatry, King's College London, Honorary Consultant Psychiatrist, National Psychosis Unit, Bethlem Royal Hospital, South London & Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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22
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Nikolova I, Petkova V, Tencheva J, Benbasat N, Voinikov J, Danchev N. Metamizole: A Review Profile of a Well-Known “Forgotten” Drug. Part II: Clinical Profile. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.5504/bbeq.2012.0135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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23
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El-Beshlawy AM, El-Alfy MS, Sari TT, Chan LL, Tricta F. Continuation of deferiprone therapy in patients with mild neutropenia may not lead to a more severe drop in neutrophil count. Eur J Haematol 2014; 92:337-40. [DOI: 10.1111/ejh.12241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 11/27/2022]
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24
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Drug-induced agranulocytosis in the Berlin case–control surveillance study. Eur J Clin Pharmacol 2013; 70:339-45. [DOI: 10.1007/s00228-013-1618-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/20/2013] [Indexed: 12/18/2022]
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25
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Michail K, Baghdasarian A, Narwaley M, Aljuhani N, Siraki AG. Scavenging of Free-Radical Metabolites of Aniline Xenobiotics and Drugs by Amino Acid Derivatives: Toxicological Implications of Radical-Transfer Reactions. Chem Res Toxicol 2013; 26:1872-83. [DOI: 10.1021/tx4002463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karim Michail
- Faculty
of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
- Faculty
of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Argishti Baghdasarian
- Faculty
of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Malyaj Narwaley
- Faculty
of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Naif Aljuhani
- Faculty
of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
- Pharmacology
and Toxicology Department, Faculty of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Arno G. Siraki
- Faculty
of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
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26
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Kobayashi S, Ogura M, Hosoya T. Acute neutropenia associated with initiation of febuxostat therapy for hyperuricaemia in patients with chronic kidney disease. J Clin Pharm Ther 2013; 38:258-61. [DOI: 10.1111/jcpt.12057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. Kobayashi
- Division of Nephrology and Hypertension; Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - M. Ogura
- Division of Nephrology and Hypertension; Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - T. Hosoya
- Division of Nephrology and Hypertension; Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
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27
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Abstract
We report the first published case of agranulocytosis induced by omeprazole and its recurrence with esomeprazole, the S-isomer form of omeprazole. Interestingly, we found an homozygotous mutation of CYP2C19*17, responsible for the metabolism of proton pump inhibitors.
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28
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29
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Machado AP, Silva MRR, Fischman O. Prolonged infection by Fonsecaea pedrosoi after antigenic co-stimulation at different sites in experimental murine chromoblastomycosis. Virulence 2011; 1:29-36. [PMID: 21178410 DOI: 10.4161/viru.1.1.9920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In the present study, we examined prolonged infection after antigenic co-stimulation by inoculation of the fungus Fonsecaea pedrosoi at two different sites in three mouse strains (BALB/c, Swiss, and C57BL/6). Using this murine model of infection, we showed that antigen induction of infection at more than one site led to a local suppression of active lesions, which increased the time course of experimental chromoblastomycosis (CBM). Footpad infection with a simultaneous infection of the peritoneum or a mucosal site appeared to cause prolonged infection and frequent fungal disseminations. Using knockout (KO) mice, we observed that antigenic co-stimulation caused progressive illness in CD8-KO animals and an effective immune response in the absence of IL-10. In Xid mice, co-stimulation provoked chronic infection (not prolonged), suggesting that B1 B cells play an important role in the control of fungal infection. The tissue response to infection was similar in all co-stimulated mouse groups, as anatomopathologic sections revealed multifocal lesions (granuloma-like). In general, these mice had acute responses at primary antigenic sites with an intense migration of polymorphonuclear leukocytes (PMNs), whereas the distant infection sites (footpad) showed signs of chronic infection. The migration of PMNs to the secondary site (footpad) increased in the later periods of infection, especially after the disappearance of the primary antigenic focus. PMN migration was associated with lesion-dormancy breakage and fungal elimination. Our findings suggest that the host inflammatory/suppression mechanisms induced by antigenic co-stimulation to systemically fight the same pathogen act coordinately through responses that differ at the sites of infection between acute and chronic integrated healing processes that are more prolonged than an acute infection at a single site. However, the long persistence of fungal cells in the host may be linked to microbial adaptation to a parasitic infection as observed in co-stimulated Xid mice.
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Affiliation(s)
- Alexandre Paulo Machado
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Cuiabá, Brasil.
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30
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Apinantriyo B, Lekhakula A, Rujirojindakul P. Incidence, etiology and bone marrow characteristics of non-chemotherapy-induced agranulocytosis. ACTA ACUST UNITED AC 2011; 16:50-3. [PMID: 21269568 DOI: 10.1179/102453311x12902908411715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Agranulocytosis is a rare but fatal condition. The majority of cases are associated with drugs. However, in-patient incidences and the relationship between clinical outcomes and bone marrow characteristics have not been established. METHODS We conducted a retrospective study in a university hospital. A total of 38 in-patients diagnosed with agranulocytosis were analyzed. RESULTS The average incidence of agranulocytosis in Songklanagarind Hospital between 1993 and 2007 was 0·98 cases per 10 000 admissions per year. Antimicrobial agents were the most common etiology (63% of patients) and antithyroid agents were the second most common (13·6%). Two patterns of bone marrow were noted: type I was characterized by a left-shifted granulopoiesis and type II was recognized as having hypocellular bone marrow with markedly reduced granulocyte precursors. A significantly higher mortality was associated with type II. CONCLUSION Antimicrobial agents are the most common cause and the rare granulocyte precursors in bone marrow are associated with higher mortality rates.
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Affiliation(s)
- Benjawan Apinantriyo
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Kanchanavanich Road, Hat Yai, Thailand
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31
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Zhang X, Zhang X, Liu F, Chen X, Zhu X, Uetrecht J. Involvement of the immune system in idiosyncratic drug reactions. Drug Metab Pharmacokinet 2010; 26:47-59. [PMID: 21084762 DOI: 10.2133/dmpk.dmpk-10-rv-085] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is strong evidence that most idiosyncratic drug reactions (IDRs) are immune-mediated and are caused by reactive metabolites of a drug rather than by the drug itself. Several hypotheses have been proposed by which a drug could induce an immune response. The major hypotheses are the hapten hypothesis and the danger hypothesis; however, the characteristics and spectrum of IDRs are different with different drugs, and this likely reflects mechanistic differences; therefore, no one hypothesis is likely to explain all IDRs. Some IDRs appear to involve epigenetic effects, direct activation of antigen-presenting cells, or disturbing the normal balance of the immune system. It has been suggested that many cases of idiosyncratic liver injury are not immune-mediated, and other mechanisms such as mitochondrial injury may be involved. It is essential that any hypothesis be consistent with the clinical characteristics of the IDR. Although the characteristics of most idiosyncratic liver injury do not suggest that mitochondria are the major target, it is quite possible that milder mitochondrial injury could stimulate an immune-mediated reaction. The observation that IDRs can vary widely among different drugs and different patients is most easily explained by an immune mechanism in which the target of the immune response is different.
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Affiliation(s)
- Xiaochu Zhang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
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32
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Basak GW, Drozd-Sokołowska J, Wiktor-Jedrzejczak W. Update on the Incidence of Metamizole Sodium-Induced Blood Dyscrasias in Poland. J Int Med Res 2010; 38:1374-80. [DOI: 10.1177/147323001003800419] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Metamizole sodium (metamizole) is a popular non-opioid analgesic and a common non-prescription product in Poland. Controversy exists regarding the level of risk of agranulocytosis or aplastic anaemia associated with its use. Two previous pharmacovigilance studies conducted in Poland found the risk was low. Twenty-four of the 25 haematology centres that provide specialist care for the 30 million adults in Poland participated in this prospective 12-month study. Twenty-one cases of agranulocytosis, 48 of aplastic anaemia, 15 of neutropenia and 11 of pancytopenia were reported. Of these cases, three (two agranulocytosis; one aplastic anaemia) were judged as being possibly related to metamizole. Crude estimates of the rate of agranulocytosis and aplastic anaemia associated with metamizole were 0.16 and 0.08 cases/million person-days of use, respectively. Ongoing national safety surveillance in Poland shows that, despite the possibility of drug-induced blood dyscrasias with metamizole, the risk is very low.
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Affiliation(s)
- GW Basak
- Department of Haematology, Oncology and Internal Diseases, The Medical University of Warsaw, Warsaw, Poland
| | - J Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Diseases, The Medical University of Warsaw, Warsaw, Poland
| | - W Wiktor-Jedrzejczak
- Department of Haematology, Oncology and Internal Diseases, The Medical University of Warsaw, Warsaw, Poland
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33
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Pontikoglou C, Papadaki HA. Idiosyncratic Drug-Induced Agranulocytosis: The Paradigm of Deferiprone. Hemoglobin 2010; 34:291-304. [DOI: 10.3109/03630269.2010.484791] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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34
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Buchanan JA, Oyer RJ, Patel NR, Jacquet GA, Bornikova L, Thienelt C, Shriver DA, Shockley LW, Wilson ML, Hurlbut KM, Lavonas EJ. A confirmed case of agranulocytosis after use of cocaine contaminated with levamisole. J Med Toxicol 2010; 6:160-4. [PMID: 20358411 PMCID: PMC3550277 DOI: 10.1007/s13181-010-0060-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
More than 2 million Americans use cocaine each month (National Survey on Drug Use and Health, Department of Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA) & Office of Applied Studies (OAS), Rockville, MD 2007). Starting in early 2003, South American cocaine cartels began to add levamisole, a pharmaceutical agent, to bulk cocaine prior to shipment to the USA (Valentino and Fuentecilla 2005). A dramatic increase in the prevalence of levamisole in cocaine was noted in early 2008. By October, 30% of cocaine bricks analyzed by the United States Drug Enforcement Administration contained levamisole (Casale et al. 2008). Exposure to levamisole can cause agranulocytosis (Amery and Bruynseels 1992). We report the first confirmed case of agranulocytosis associated with consumption of levamisole-contaminated cocaine in the USA. A previously healthy adult male presented to the emergency department with 5 days of mouth pain. He admitted to chronic active ethanol and crack cocaine abuse. Laboratory studies revealed severe neutropenia, with an absolute neutrophil count of 19 cells/mm³ (normal = 1,500-8,000 cells/mm³). A urine screen for drugs of abuse was positive for cocaine metabolites and opiates. Evaluation of a peripheral blood smear showed leukopenia with severe absolute neutropenia. A bone marrow biopsy revealed recently injured bone marrow showing early recovery. While in the hospital, the patient had little spontaneous bone marrow recovery. He received granulocyte colony-stimulating factor with improvement in peripheral white blood cell counts. The residue in the patient's crack pipe contained 10% levamisole. Subsequently, levamisole was detected in the patient's urine. Levamisole-associated agranulocytosis should be considered in the diagnosis of patients who present with neutropenia and a history or evidence of cocaine use.
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Affiliation(s)
- Jennie A Buchanan
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.
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35
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Abstract
Numerous medications and other xenobiotics are capable of producing adverse reactions (ADRs) affecting red cells, platelets or neutrophils. Occasionally, more than one blood element is affected simultaneously. As with all drug reactions, some side effects are a direct consequence of a known pharmacologic action of the drug and are dose-dependent; others occur sporadically and relatively independent of dose. The latter ("idiosyncratic") reactions are unpredictable and, in general, have no known underlying genetic basis. Many are antibody-mediated, as would be expected since cellular immune effector cells have little direct access to circulating blood cells. In this chapter, we will discuss idiosyncratic drug reactions affecting blood and blood forming tissues with an emphasis on those thought to be immune-mediated.
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Affiliation(s)
- Richard H Aster
- Blood Research Institute, Blood Center of Wisconsin, 2178 Watertown Plank Rd, Milwaukee, WI 53201, USA.
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Guardiola PD, Tenreiro AP. [A serious adverse effect: sepsis due to carbimazole]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2009; 56:378-380. [PMID: 19883898 DOI: 10.1016/s1575-0922(09)72457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 07/15/2009] [Indexed: 05/28/2023]
Abstract
Thyonamides are widely used drugs to treat hyperthyroidism, because of their efficacy and security. However, although with less frequency, they can cause hepatic and haemathologic toxicity. Neutropenia produced for this kind of drugs, can be very serious, to such an extent it may jeopardize patient's life. If it appears, it is necessary to stop the antithyroid treatment and, if the patient have fever or agranulocytosis, start wide spectrum antibiotics and definitive treatment with radioiodine or surgery. A file case report of a 26-years-old woman with a thyrotoxicosis secondary to Graves' disease in treatment with carbimazole. She suffered a serious sepsis, as a consequence of the drug induced neutropenia.
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Tesfa D, Keisu M, Palmblad J. Idiosyncratic drug-induced agranulocytosis: possible mechanisms and management. Am J Hematol 2009; 84:428-34. [PMID: 19459150 DOI: 10.1002/ajh.21433] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The incidence of drug-induced neutropenia has not changed in the western hemisphere over the last 30 years. Yet, the drug panorama has changed considerably. This implies that host factors may play an intriguing role for this idiosyncratic reaction. The knowledge as to mechanisms for the reaction has advanced with emerging understanding of neutropoiesis and immune regulation. Nonetheless, it is still remarkably difficult to pinpoint why and how a drug causes this unexpected, severe adverse event in a patient. Patient characteristics, e.g. genetics, appear to be keys for better understanding, predictions and prevention. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Daniel Tesfa
- Departments of Medicine and Hematology Center, Karolinska Institutet at Karolinska University Hospital Huddinge, S-14186 Stockholm, Sweden.
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Un effet indésirable grave du traitement antituberculeux : la thrombopénie au pyrazinamide. Rev Mal Respir 2008; 25:1142-4. [DOI: 10.1016/s0761-8425(08)74987-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Federici L, Weitten T, Alt M, Blaison G, Zamfir A, Audhuy B, Maloisel F, Andrès E. [Idiosyncratic drug-induced agranulocytosis]. Presse Med 2008; 37:1327-33. [PMID: 18644319 DOI: 10.1016/j.lpm.2008.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 03/12/2008] [Indexed: 11/18/2022] Open
Abstract
Idiosyncratic drug-induced agranulocytosis is a potential adverse event of most drugs, rare but life-threatening. Its annual incidence does not exceed 10 cases per million population in Europe and has remained stable over the past two decades. Its pathogenesis is poorly understood. The principal drugs associated with it are antithyroid drugs, antibiotics including trimethoprim, sulfamethoxazole, and beta-lactamines, ticlopidine, sulfasalazine and dipyrone. Clinical presentation is highly variable but a severe infection is observed in more than one third of cases. Poor prognostic factors include a neutrophil count under 100/mm(3), age > 65 years, septicemia or shock, and severe comorbidity. Improvement in the management of infectious complications and the use of hematopoietic growth factors in severe cases helps explain that mortality rate has fallen to less than 5%.
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Affiliation(s)
- Laure Federici
- Service de médecine interne, Hôpital Pasteur, F-68000 Colmar, France
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Andrès E, Federici L, Weitten T, Vogel T, Alt M. Recognition and management of drug-induced blood cytopenias: the example of drug-induced acute neutropenia and agranulocytosis. Expert Opin Drug Saf 2008; 7:481-9. [DOI: 10.1517/14740338.7.4.481] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Incidence and risk factors for agranulocytosis in Latin American countries—the Latin Study. Eur J Clin Pharmacol 2008; 64:921-9. [DOI: 10.1007/s00228-008-0513-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 05/20/2008] [Indexed: 11/27/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Acute agranulocytosis is a rare, potentially life-threatening condition, which is attributable to drugs in > 70% of cases. Agranulocytosis is characterised by a peripheral neutrophil count < 0.5 x 10(9)/l. It often manifests with a severe sore throat, but isolated fever, pneumonia or septicaemia are not uncommon. Agranulocytosis may be caused by many drugs. High-risk drugs include antithyroid drugs, clozapine, ticlopidine, sulfasalazine, dipyrone, trimethoprim/sulfamethoxazole, carbamazepine and probably rituximab. Suspect drugs should be stopped immediately. In febrile patients, blood cultures and, where indicated, site-specific cultures should be obtained and treatment with empirical broad spectrum antibiotics started. Haematopoietic growth factors should be considered in patients with poor prognostic factors (e.g., a neutrophil count < 0.1 x 10(9)/l), severe clinical infection or severe underlying disease or comorbidity. Case fatality has decreased to ~ 5% in recent years, probably owing to improved intensive care treatment and increased alertness of physicians to this severe adverse reaction.
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Affiliation(s)
- Edeltraut Garbe
- University Professor of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany.
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