Chlorpromazine eosinophilia

Skin reactions occur early in therapy but can subside with continued treatment. Jaundice, which can also occur early, is of the cholestatic type, similar to that attributed to chlorpromazine. Agranulocytosis is a rare complication, as are cases of leukocytosis, leukopenia, and eosinophilia. There are no data on the incidence of antidepressant-induced agranulocytosis, except to note that it is rare with all of the agents discussed in this chapter. 

Rarely reported hematological reactions to various neuroleptic drugs include agranulocytosis, thrombocytopenic purpura, hemolytic anemia, leukopenia, and eosinophilia. These are thought to represent allergic or hypersensitivity reactions, although this has been questioned in one detailed case report of chlorpromazine-induced agranulocytosis (514). 

Acebutolol Alpha-methyl-dopa Captopril Carbimazole Chlorpromazine Dihydralazine Fludarabine Hydralazine Infliximab Interferons-alpha Iproniazid Isoniazid Nomifensine Penicillamine D-Penicillamine Practolol Procainamide Propylthiouracil rlL-2 Simvastatin Tienilic acid Tryptophan contaminants Zimeldine Lupus syndrome Autoimmune haemolytic anaemia Pemphigus ANCA-associated vasculitis Lupus syndrome Autoimmune hepatitis Autoimmune haemolytic anaemia Lupus syndrome, ANCA-associated vasculitis Lupus syndrome Wide range of autoimmune diseases Autoimmune hepatitis Lupus syndrome Autoimmune haemolytic anaemia Myasthenia, dermatomyositis Anti-GBM (Goodpasture) disease Oculocutaneomucous syndrome Lupus syndrome ANCA-associated vasculitis Autoimmune thyroiditis Lupus syndrome Autoimmune hepatitis Eosinophilia myalgia syndrome (see section 9.3.5) Guillain-Barre syndrome... 

Blood Dyscrasias Mild leukocytosis, leukopenia, and eosinophilia occasionally occur with antipsychotic treatment, particularly with clozapine and less often with phenothiazines of low potency. It is difficult to determine whether leukopenia that develops during the administration of such agents is a forewarning of impending agranulocytosis. This serious comphcation occurs in not more than 1 in 10,000 patients receiving chlorpromazine or other low-potency agents (other than clozapine) it usually appears within the first 8-12 weeks of treatment. 

A mild jaundice, typically occurring early in therapy, may be seen in some patients receiving chlorpromazine. Pruritus is rare. The reaction probably is a manifestation of hypersensitivity, because eosinophilia and eosinophilic infiltration of the liver occur. For uninterrupted drug therapy in a patient with neuroleptic-induced jaundice, it probably is safest to use low doses of a potent, dissimilar agent. Hepatic dysfunction with other antipsychotic agents is uncommon. Clozapine can cause potentially severe ileus and sialorrhea. 

The phenothiazines, of which chlorpromazine is the prototype, have been reported to produce a variety of clinical reactions apparently on an allergic basis including rash, eosinophilia, cholestatic jaundice, agranulocytosis, vasculitis, systemic lupus erythematosus (SLE), and hemolytic anemia (Parker 1980 a van Arsdel 1978). 

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