These drugs may be used to prevent bacterial infections, and are used to treat infections that have developed. She was started on maximum 60mg 20mg tid oral dose of carbimazole since one month by her treating physician. Agranulocytosis is a serious condition, with an estimated incidence of 1. Druginduced agranulocytosis is a rare, potentially fatal idiosyncratic reaction that can occur unpredictably with a wide variety of drugs when taken in a conventional dose. Always seek professional medical advice about any treatment or change in treatment plans. The nature of this idiosyncratic interaction differs for diffefent drugs and possibly for different individuals. This is a serious entity with high mortality reaching up to 40%. It is a severe lack of one major class of infectionfighting white blood cells. They result from an adverse interaction between the drug and the haemopoietic pathway in certain susceptible individuals. It is currently licensed for use in treatmentresistant schizophrenia and psychosis in parkinsons disease, but its use in old age psychiatry is very uncommon.
Pdf neutropenia, agranulocytosis and dipyrone nelson. At a glance druginduced neutropenia is characterized by a decline in absolute neutrophil counts precipitated by exposure to a medication. Without monitoring, agranulocytosis occurs in about 1% of people who take clozapine during the first few months of treatment. Idiosyncratic druginduced agranulocytosis or acute neutropenia is an adverse event resulting in a neutrophil count of under 0. The most common druginduced hematologic disorders include aplastic anemia, agranulocytosis, megaloblastic anemia, hemolytic anemia, and thrombocytopenia. Indeed, one drug might cause agranulocytosis by different mechanisms in different patients. Agranulocytosis including fatal cases has been reported with other agents in the class. Clozapine, agranulocytosis, and benign ethnic neutropenia. Management and prevention of agranulocytosis in patients. Since the publication of a major international casecontrol study on the risk of agranulocytosis associated with the use of medicines in the 1980s, many new drugs have been introduced in therapeutics. The mechanism of clozapine induced agranulocytosis is not clear. Almost all classes of medicines have been implicated in agranulocytosis. Review of the literature of reported cases of agranulocytosis between 1999 and 20 identified 80 cases where the presenting symptoms were described,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37.
Severe druginduced agranulocytosis successfully treated. However, the mortality rate during the acute phase is high, and therefore prompt supportive therapy with isolation and broadspectrum antibiotics for infection are mandatory during periods of severe neutropenia. Agranulocytosis management and treatment cleveland clinic. Review of reported cases of antithyroid drug induced agranulocytosis in the literature. State of art of idiosyncratic druginduced neutropenia or. Agranulocytosis, although not common, is a serious complication of thionamide therapy. Clozapine is one of the most effective drugs available to psychiatrists for treating psychosis. Patients with such severe neutropenia are likely to. Pdf agranulocytosis associated with dipyrone metamizol. Clinicians should be aware of the possible relationship between levamisoleassociated agranulocytosis and use of cocaine, and possibly heroin, and should obtain a drug history in all potential cases routinely. The meeting resulted in proposed standard designations of blood cytopenias and criteria for causality assessment of neutropenia, thrombocytopenia and aplastic anemia.
Stopping a medication that is believed to cause the disease. Mechanism of clozapineinduced agranulocytosis cns drugs. Antithyroid drugs atds induced agranulocytosis is a rare but life threatening condition. Agranulocytosis is a rare and lifethreatening condition, with an annual incidence of 1. Agranulocytosis, acquired nord national organization.
The doctor may tell you to stop taking the drug for a while to see if you improve. The risks of agranulocytosis, and related deaths, decreased with length of time on clozapine. Possible risk factors for leukopenia and neutropenia include preexisting low white blood cell count wbc or absolute neutrophil count anc and history of drug induced leukopenia or neutropenia. Treatment of drug induced agranulocytosis with haematopoietic growth factors although drug induced agranulocytosis is infrequent, it is of concern as the mortality rate ranges from 6 to 10%.
Agranulocytosis induced by nonchemotherapy drugs article pdf available in annals of internal medicine 1484. Carbimazoleinduced agranulocytosis a rare case report. In this article, we discuss its diagnosis and management and we consider the drugs most commonly involved and ways of minimising risk. Idiosyncratic druginduced agranulocytosis or acute neutropenia.
In the case of penicillin induced agranulocytosis, the patient can often begin taking penicillin again, at a lower dosage, after the neutropenia has resolved without any relapse of drug induced agranulocytosis. Agranulocytosis can be treated in a number of ways. Clinical and hematologic characteristics of phenothiazine induced agranulocytosis suggest that the mechanisms underlying the development of this condition are related to a possible suppressive effect of phenothiazines on cell division. Methimazoleinduced agranulocytosis in patients with. Antithyroid druginduced agranulocytosis article pdf available in hong kong medical journal xianggang yi xue za zhi hong kong academy of medicine 54. The incidence of idiosyncratic druginduced hematologic disorders varies depending on the condition and the associated drug. Drug induced neutropenia or agranulocytosis has been associated with many types of drugs and often is associated with a fatal outcome. Management of drug induced agranulocytosis includes the immediate discontinuation of the offending medication, initiation of broadspectrum antibiotics and consideration of the use of granulocyte colonystimulating factors in highrisk patients. Usually, the wbc count returns to normal over a period of 12 weeks after discontinuing the offending drug and the time taken can range from 7 to 56 days. Nonchemotherapy druginduced agranulocytosis annals of. In approximately 5% of cases drug induced agranulocytosis may be fatal.
Populationbased druginduced agranulocytosis hematology. Colombian cocaine producers increase use of a harmful cutting agent. Patient knowledge of antithyroid druginduced agranulocytosis. Aplastic anaemia and agranulocytosis are uncommon but serious adverse effects of drug therapy.
Clozapine carries a black box warning for drug induced agranulocytosis. During 20062010, without any monitoring system, the maximum annual incidence of agranulocytosis caused by clozapine would have been 0. We do not consider the doserelated granulocytopenia that commonly. Nonchemotherapy drug induced agranulocytosis is a rare adverse reaction that is characterized by a decrease in peripheral neutrophil count to less than 0. Adverse reactions to drugs are an important cause of hospitalacquired illness, occurring in 10% to 18% of medical patients 1 and producing fatality rates of up to %. Agranulocytosis secondary to viral infections is usually selflimited, and patients with such conditions have a good prognosis. Characterizing neutrophilgenerated metabolites of a model compound, dmp 406, and assessing the relevance of an in vitro apoptosis assay for identifying drugs that may cause agranulocytosis. Up to 50% of agranulocytosis may be induced by nonchemotherapy drugs, such as antithyroid agents and antimicrobial medications. Pdf agranulocytosis induced by nonchemotherapy drugs. Neutropenia can occur at any time during the course of. During 19932011 141 cases of agranulocytosis, with four deaths, were recorded in association with clozapine. It is a heterogeneous disorder in pathogenetic terms, not surprisingly in view of its idosyncratic nature. Agranulocytosis is defined as an absolute neutrophil count anc agranulocytosis in patients taking clozapine ranges from 12% after 1 year of therapy and can be fatal if not detected and treated early.
Possible mechanisms and management daniel tesfa,1 marianne keisu,2 and jan palmblad1 the incidence of drug induced neutropenia has not changed in the western hemisphere over the last 30 years. Antithyroid druginduced agranulocytosis article pdf available in journal of the chinese medical association 728. Agranulocytosis associated with dipyrone metamizol article pdf available in european journal of clinical pharmacology 6011. We report a 29 years filipino female diagnosed as having hyperthyroidism with normal base line blood counts, liver and renal profile. Druginduced agranulocytosis in the outpatient setting is a rare but potentially fatal adverse effect of many classes of medications. Drug induced thrombocytopenia is the most common drug induced hematologic disorder, with reports suggesting that between 0.
Over the last 20 years, the incidence of idiosyncratic druginduced agranulocytosis or acute neutropenia has remained stable at 2. The list of treatments mentioned in various sources for agranulocytosis includes the following list. If other methods do not work, you might need to take shots of a hormone that stimulates the bone marrow to produce more granulocytes. In this chapter, we report and discuss the diagnosis and management of idiosyncratic drug induced, or drug associated, severe neutropenia, and agranulocytosis neutrophil count of agranulocytosis. Clozapine is an atypical antipsychotic agent that has several advantages over conventional antipsychotics, not least of which is its superior efficacy. Druginduced agranulocytosis is usually a selflimiting condition provided toxic drugs are withdrawn with complete resolution within two weeks. Drug induced agranulocytosis occurs within 12 months of taking the antithyroid medication but the onset can get delayed. Agranulocytosis occurs in about 1% of patients taking clozapine.