Aminopyrine agranulocytosis

Uetrecht JP, Ma HM, MacKnight E, et al. Oxidation of aminopyrine by hypochlorite to a reactive dication possible implications for aminopyrine-induced agranulocytosis. Chem Res Toxicol 1995 8(2) 226-233. 

Blood dyscrasias, mostly dose independent, are among the most important allergic-type adverse reactions to drugs. Aplastic anemia is a serious but rare (presumably) idiosyncratic reaction. It has been reported in association with chloramphenicol, quinacrine, phenylbutazone, mephenytoin, gold compounds, and potassium chlorate. Hemolytic anemia, thrombocytopenia, and agranulocytosis may result from an unusual, acquired sensitivity to a variety of widely used drugs including aminopyrine, phenylbutazone, phenothiazines, propylthiouracil, diphenylhydantoin, penicillins, chloramphenicol, sulfisoxazole, and tolbutamide. 

Deliberate adulteration of botanical products is not limited to substitution of one plant for another. Various TCMs have been found to contain undeclared synthetic medicinal ingredients. Four patients developed agranulocytosis after ingesting an herbal arthritis pain relief product called Chui Fong, which contained aminopyrine and phenylbutazone (Ries and Sahud, 1975). A TCM called Black Pearl was found to contain hydrochlorothiazide, diazepam, indomethacin and mefenamic acid (By et al., 1989). Investigators have also reported the presence of corticosteroids (including hydrocortisone) in herbal TCMs (Goldman and Myerson, 1991 Joseph et al.,... 

Ries, C.A. and Sahud, M.A. (1975) Agranulocytosis caused by Chinese herbal medicines. Dangers of medications containing aminopyrine and phenylbutazone. JAMA. 231, 352-355. 

It has antipyretie aetions similar to those of phenazone but owing to the risk of agranulocytosis its use is discouraged and mostly abandoned. However, the gentisate has sometimes been used. Aminopyrine is often employed in drug metabolism studies. 

The first drug documented as causing immunologically mediated agranulocytosis was aminopyrine. Leukoagglutinins to aminopyrine were demonstrated and granulocytopenia could be transferred passively by serum to normal volun-... 

Table 9. Culture of lymphocytes from patients with drug-induced agranulocytosis in the presence of heterologous or autologous serum and aminopyrine...

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