Hematologic reactions

Nausea, vomiting, diarrhea, hypersensitivity reactions, nephrotoxicity, headache, hematologic reactions Same as cefaclor... 

Monitoring Monitor for hematologic reactions common to sulfonamides. Obtain baseline CBC and platelet counts before therapy and at regular intervals during therapy. 

Hematologic Patients with a history of adverse hematologic reaction to any drug may be particularly at risk. 

Adverse effects resulting from gold-accumulation in tissues can include lesions of the mucous membranes, skin eruptions varying from erythema to severe exfoliative dermatitis, proteinuria and nephrosis. A serious hematologic reaction is aplastic anemia. A rather high incidence of gastrointestinal disturbances is seen in patients on auranofin. 

Carbamazepine causes a variety of rashes and other allergic reactions including fever, hepatosplenomegaly, and lymphadenopathy, but the incidence of serious hypersensitivity reactions is rare. Systemic lupus erythematosus can occur, but discontinuation of the drug leads to eventual disappearance of the symptoms. Idiosyncratic hematological reactions to carbamazepine... 

CBZ should not be used when there is a history of drug-induced hematological reactions bone marrow suppression hypersensitivity to this agent or other tricyclics and/or hepatic dysfunction. 

Rare but serious adverse effects of all anti-TNF agents also include severe hepatic reactions leading to acute hepatic failure, demyelinating disorders, hematologic reactions, and new or worsened congestive heart failure in patients with underlying heart disease. 

Hematologic reactions (leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, pancytopenia)... 

Adverse Reactions Hypoglycemia Gastrointestinal disturbances (nausea, diarrhea, constipation, gastralgia) Dermatologic reactions (erythema, morbilliform or maculopapular eruptions, urticaria, pruritus, and eczema) Hematologic reactions (leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, pancytopenia) Metabolic reactions (hepatic porphyria, disulfiram-like reactions) Hyponatremia Elevated liver enzymes... 

Hematologic reactions (asymptomatic subnormal serum vitamin B,2 levels)... 

Side-effects are rare and may include hematological reactions, leucopenia, agranulocytosis and other hypersensitivity reactions. Paracetamol has a narrow therapeutic dose range and overdosage induces severe liver and renal damage (Lewis and Paloucek, 1991) via accumulation of a toxic metabolite, N- acetyl-benzoquinoneimine (NABQI). Acetylcysteine or methionine, which increase glutathione conjugation of the metabolite, are used as the antidote. 

Clopidogrel STEMI (10), NSTEMI (11) Elective PCI (l 2) 300 mg loading dose (10-12) unless PCI to be performed within eight hours in which case 600 mg recommended As effective as ticlodipine in preventing stent thrombosis (9) Reduced incidence of adverse hematologic reactions compared to ticlodipine (9)... 

J.L. Sobotka, et al., A review of carbamazepine s hematologic reactions and monitoring recommendations. DICP Ann. Pharmacother. 24 1214-1219, 1990. 

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). 

Six cases of hematological reactions, including leukopenia, granulocytopenia, and neutropenia, were reported in Canada in the 2 years after the approval of the drug in 1996 (205). 

Fraunfelder FT, Meyer SM, Bagby GC, Dreis MW. Hematologic reactions to carbonic anhydrase inhibitors. Am J Ophthalmol 1985 100 79-81. 

Yunis A A. Effects of chloramphenicol on erythropoiesis. In Dimitrov NV, Nodine JH, editors. Drugs and Hematological Reactions. London, New York Grune and Stratton, 1974 133. 

The pathogenesis of hematological reactions to penicillamine is uncertain, but the available evidence suggests that pharmacological as well as immunological processes may be involved (142-144). 

Penicillamine can cause other serious hematological reactions such as agranulocytosis and aplastic anemia (27,144,146,158-167). 

Pure red-cell aplasia developed in a 40-year-old woman as a rare idiosyncratic hematological reaction to penicillamine (105). Withdrawal of the drug, which had been taken in a daily dose of 500 mg for rheumatoid arthritis, and a short course of glucocorticoids was followed by permanent recovery. 

Several case reports have demonstrated that penicillamine can cause hver damage (SEDA-13, 199) (184), mainly cholestatic hepatitis, often associated with other signs of hypersensitivity such as fever, rash (185), and pulmonary (159,186) or hematological reactions (162). In two children with Wilson s disease, penicillamine was thought to have caused persistence of a pre-existing increase in aminotransferase activity (187). 

Pyrimethamine 50 mg/day has been nsed in combination with clindamycin for the treatment of Toxoplasma encephalitis in AIDS. Adverse effects were common (rash, diarrhea, nansea), bnt the incidence of hematological reactions was lower than with the combination of snlfadiazine and pyrimethamine (SEDA-16, 309). 

Hematological reactions, such as thrombocytopenia and leukopenia, occur in about 6-9% of patients using tiopronin (1,5). 

Frequent laboratory monitoring may be warranted for agents commonly demonstrating severe hematologic reactions. 

Chloramphenicol causes both dose-dependent and dose-independent hematologic reactions. Fatal aplastic anemia occurs in genetically susceptible patients taking chloramphenicol on a long-term basis. Reversible and dose-dependent disturbances of hemopoiesis can also arise, and are characterized by the altered maturation of red blood cells, vacuolated nucleated red blood cells in the marrow, and reticulocytopenia. 

Human Toxicity Dermatitis, stomatitis, hepatitis, nephritis, G.I. disturbances, hematologic reaction may occur. Antidote Dimercapro] (BAL). 

A variety of allergic, hepatotoxic, and hematologic reactions to the benzodiazepines may occur, but the incidence is quite low these reactions have been associated with the use of flurazepam and triazolam but not with temazepam. Large doses taken just before or during labor may cause hypothermia, hypotonia, and mild respiratory depression in the neonate. Abuse by the pregnant mother can result in a withdrawal syndrome in the newborn. 

Hypersensitivity reactions include morbilliform rash in 2—5% of patients and occasionally more serious skin reactions, including Stevens-Johnson syndrome. Systemic lupus erythematosus and potentially fatal hepatic necrosis have been reported rarely. Hematological reactions include neutropenia and leucopenia, or more rarely, red-cell aplasia, agranulocytosis, and thrombocytopenia Lymphadenopathy is associated with reduced immunoglobulin A (IgA) production. Hypoprothrombinemia and hemorrhage have occurred in the newborns of mothers who received phenytoin during pregnancy vitamin K is effective treatment or prophylaxis. 

UNTOWARD EFFECTS Adverse reactions to isoniazid occur in 5%, including rash (2%), fever (1.2%), jaundice (0.6%), and peripheral neuritis (0.2%). Isoniazid hypersensitivity may result in fever, rashes, and hepatitis. Hematological reactions also may occur (e.g., agranulocytosis, eosinophilia, thrombocytopenia, and anemia). Vasculitis associated with antinuclear antibodies may appear but disappears when the drug is stopped. 

CBZ should be used with caution in patients with a history of congestive heart failure or cardiac arrhythmias (because it may aggravate them) and with a history of hematologic reactions to other drugs or hypersensitivity to tricyclic antidepressants. Blood levels should be monitored in patients with renal or hepatic impairment. 

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