Agranulocytosis neutropenia

Ticlopidine can cause life-threatening hematological adverse reactions, including neutropenia/agranulocytosis and thrombotic thrombocytopenic purpura (TTP). Neutropenia/agranulocytosis Neutropenia defined as an absolute neutrophil count (ANC) less than 1,200 neutrophils/mm occurred in 50 of 2048 (2.4%) stroke patients who received ticlopidine in clinical trials. Neutropenia is calculated as follows ANC = WBC x % neutrophils. In 17 patients (0.8%) the neutrophil count was less than 450/mm. ... 

Neutropenia/Agranulocytosis Neutropenia (less than 1000/mnr ) with myeloid hypoplasia resulted from captopril use. About half of the neutropenic patients developed systemic or oral cavity infections or other features of agranulocytosis. Neutropenia/agranulocytosis has occurred rarely with enalapril or lisinopril and in 1 patient on quinapril. Data are insufficient to show that moexipril, ramipril, quinapril, benazepril, trandolapril, orfosinopril do not cause agranulocytosis at similar rates. Periodically monitor WBC counts. 

Neutropenia/Agranulocytosis Neutropenia and rare cases of agranulocytosis have been reported. Discontinue isotretinoin if clinically significant decreases in white cell counts occur. 

Thrombocytopenia, agranulocytosis, neutropenia, aplastic anemia, and even pancytopenia have been reported in association with aspirin. The prospect for recovery from the latter is poor, mortality approaching 50%. 

Agranulocytosis, neutropenia may be noted in patients with impaired renal function or collagen vascular disease (systemic lupus erythematosus, scleroderma)... 

Agranulocytosis, neutropenia, thrombocytopenia, and erythroleu-kaemia have been reported during therapy with ticlopidine. Elevation of liver function tests are unusual with ticlopidine therapy, but occasionally cholestatic jaundice or hepatitis have been reported. Drug may increase total serum cholesterol, as well as LOL- and VLDL-cholesterol and other lipoproteins, without effecting HDL-cholesterol (1). 

Hematologic While blood dyscrasias may not be established adverse reactions to deferasirox, the recently revised data sheet of Exjade reads There have been postmarketing reports (both spontaneous and from clinical trials) of cytopenias, including agranulocytosis, neutropenia and thrombocytopenia, in patients treated with Exjade. Some of these patients died. The relationship of these episodes to treatment with Exjade is uncertain. Most of these... 

Hematologic—neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, and aplastic anemia... 

The drug was subsequently reintroduced for treatment-resistant or treatment-intolerant patients in the UK and USA in 1990. The drug is completely free of extrapyramidal side effects but has to be monitored for the development of neutropenia and agranulocytosis. Other problems include sialorrhoea, sedation, reduction in seizure... 

Agranulocytosis A severe form of neutropenia where the number of neutrophils (the major type of leucocyte or white blood cell) is very low, so reducing an individual s ability to fight infection. It is a potentially serious side effect of the atypical antipsychotic clozapine. 

Oral colchicine causes dose-dependent GI adverse effects (nausea, vomiting, and diarrhea) in 50% to 80% of patients before relief of the attack. Non-GI adverse effects include neutropenia and axonal neuromyopathy, which may be worsened in patients taking other myopathic drugs (e.g., statins) or in those with renal insufficiency. Colchicine should not be used concurrently with macrolide antibiotics (especially clarithromycin) because reduced biliary excretion may lead to increased plasma colchicine levels and agranulocytosis. 

Because ticlopidine is associated with a risk of life-threatening blood dyscrasias including TTP and neutropenia/agranulocytosis (see Warnings), reserve for patients who are intolerant or allergic to aspirin therapy or who have failed aspirin therapy. 

Biood dyscrasias Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia and thrombocytopenia in patients receiving procainamide have been reported at a rate of approximately 0.5%. Fatalities have occurred (with approximately 20% to 25% mortality in reported cases of agranulocytosis). Perform complete blood counts including white cell, differential, and platelet counts at weekly intervals for the first 3 months of therapy, and periodically thereafter. Perform complete blood counts promptly if the patient develops any signs of infection (eg. 

Significant adverse reactions include a lupus erythematosus-like syndrome of arthralgia, pleural or abdominal pain, and sometimes arthritis, pleural effusion, pericarditis, fever, chills, myalgia, and possibly related hematologic or skin lesions (after prolonged administration) neutropenia thrombocytopenia agranulocytosis (after repeated use deaths have occurred) anorexia nausea vomiting abdominal pain bitter taste diarrhea. 

Ethacrynic acid Adverse reactions may include anorexia, pain, Gl bleeding, severe neutropenia, agranulocytosis, fever, chills, confusion, fatigue, malaise, sense of fullness in the ears, blurred vision, tinnitus, hearing loss (irreversible), rash. Furosemide Adverse reactions may include anorexia, cramping, constipation, blurred vision, hearing loss, restlessness, fever, anemia, purpura, thrombocytopenia, agranulocytosis, photosensitivity, urticaria, pruritus, thrombophlebitis, muscle spasm, weakness. 

Hematologic Neutropenia eosinophilia leukopenia pancytopenia thrombocytopenia agranulocytosis granulocytopenia aplastic anemia hemolytic anemia epistaxis menorrhagia hemorrhage bruising hemolysis, ecchymosis (naproxen). 

Agranulocytosis In clinical trials, two patients treated with mirtazapine developed agranulocytosis and a third patient developed severe neutropenia. All 3 patients recovered after mirtazapine was stopped. 

Hematologic/Lymphatic Anemia hemolytic anemia thrombocytopenia thrombocytopenic purpura eosinophilia leukopenia granulocytopenia neutropenia bone marrow depression agranulocytosis reduction of hemoglobin or hematocrit prolongation of bleeding and prothrombin time decrease in WBC and lymphocyte counts increase in lymphocytes, monocytes, basophils, and platelets. Hypersensitivity Adverse reactions (estimated incidence, 1% to 10%) are more likely to occur in individuals with previously demonstrated hypersensitivity. In penicillin-sensitive individuals with a history of allergy, asthma, or hay fever, the reactions may be immediate and severe. 

Hematologic- Eosinophilia transient neutropenia leukocytosis leukopenia thrombocythemia thrombocytopenia agranulocytosis granulocytopenia hemolytic anemia bone marrow depression pancytopenia decreased platelet function anemia aplastic anemia hemorrhage. 

Nausea vomiting diarrhea (clindamycin 3.4% to 30%) pseudomembranous colitis (clindamycin 0.01% to 10% 3 to 4 times more frequent with oral administration) neutropenia (sometimes transient) leukopenia agranulocytosis thrombocytopenic purpura skin rashes, urticaria, erythema multiforme anaphylaxis jaundice liver function test abnormalities (serum transaminase elevations). 

T. and Alt, M. (2008) Recognition and management of drug-induced blood cytopenias the example of drug-induced acute neutropenia and agranulocytosis. Expert Opinion on Drug Safety, 1, 481-489. 

Mild to moderate side effects, including nausea, vomiting, abdominal pain, diarrhea, anorexia, and headache, occur in up to 33% of patients taking this drug. Skin rash and discoloration, fever, reversible male infertility, and liver enzyme elevation occur less frequently. Rare hematological abnormalities, such as agranulocytosis, aplastic anemia, hemolytic anemia, neutropenia, or other blood dyscrasias, can be fatal. Hypersensitivity reactions occur rarely. 

Agranulocytosis and neutropenia maybe noted in those with collagen vascular disease, including scleroderma and systemic lupus erythematosus, and impaired renal function. 

Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia, and thrombocytopenia have been reported and may occur within the first 12 wk of therapy at recommended doses. Caution should be used in patients with preexisting marrow failure or cytopenia,... 

Due to the risk of life-threatening neutropenia or agranulocytosis and cost, t iclopi-dine should be reserved for patients intolerant to aspirin or who fail aspirin... 

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