Neutropenia mirtazapine

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. 

In preliminary clinical trials, 2 of 2,796 mirtazapine-treated patients developed agranulocytosis, and 1 developed severe neutropenia. All 3 patients recovered after medication discontinuation, and other possible etiologies were present in at least 1 of these individuals. Thirteen patients with pretreatment neutropenia did develop more severe neutropenia or agranulocytosis. Postmarketing evaluation to date has not established a causal relation between mirtazapine and agranulocytosis. Routine laboratory monitoring is not currently recommended. 

Rare adverse event of severe neutropenia (3 of 2,796 patients) uncertain causal relationship to mirtazapine treatment Reboxetine... 

The neutropenia in this case was consistent with an effect of mirtazapine. This is presumably an uncommon adverse effect, but this case reinforces advice given in the British National Formulary that patients taking mirtazapine should be advised to report any sore throat, fever, or stomatitis. 

Ozcanli T, Unsalver B, Ozdemir S, Ozmen M, Sertraline and mirtazapine-induced severe neutropenia, Am J Psychiatry 2005 162 1386. 

Toprak SK, Erdogan E, Azap OK. Mirtazapine-induced thrombocytopenia and neutropenia. Turk J Hematol 2012 29 297-8. 

Haematologic A case of quetiapine- and valproate-associated neutropenia and thrombocytopenia has been described after previous lamotrigine-induced Stevens-Johnson syndrome [226 ]. Two cases of neutropenia have been reported with the concomitant use of quetiapine and sodium valproate in elderly patients [227 ]. Another case of neutropenia in a 21-year-old male who was also on mirtazapine resolved following switch to ziprasidone is reported [228 ]. 

---