B and c vaccination, a listeriafree diet, tuberculosis screening and. The most important series devoted to antithyroid druginduced severe neutropenia and agranulocytosis are japanese studies, almost specifically in relation to the intake of methimazole. Since blood counts are monitored routinely these days in both. Autoimmune neutropenia is the presence of abnormally small numbers of neutrophils in the circulating blood, caused by an autoimmune condition where the body destroys neutrophils faster than they can be produced.
In approximately 5% of cases drug induced agranulocytosis may be fatal. This prediction model, studied and applied in the prevalidation study pessina et al. Nonchemotherapy idiosyncratic druginduced neutropenia idin is a relatively rare but potentially fatal disorder that occurs in susceptible individuals, with an incidence of 2. Reblozyl must be given by a healthcare professional and therefore, will only be covered under the medical. Drug induced thrombocytopenia is the most common drug induced hematologic disorder, with reports suggesting that between 0. List of autoimmune neutropenia medications 1 compared.
May 01, 2007 nonchemotherapy druginduced agranulocytosis is a rare adverse reaction that is characterized by a decrease in peripheral neutrophil count to less than 0. Herein we present a case of probable vancomycin induced neutropenia which resolved with discontinuation of the antibiotic. The incidence is about 10 cases per million per year. Pdf management of chemotherapy induced neutropenia an.
Druginduced neutropenia associated with antineutrophil. Biologic diseasemodifying antirheumatic drug bdmard. Criteria for assessing the causal relation between a given drug therapy and neutropenia, rash, or fever were defined according to kramer et al. Numerous drugs have been associated with neutropenia. State of art of idiosyncratic druginduced neutropenia or. Affected patients typically experience severe neutropenia within several weeks to several months after first exposure to a drug, and mortality is 5%. Drug induced neutropenia can occur in association with various analgesics, psychotropics, anticonvulsants, antithyroiddrugs, antihistaminics, nonsteroidal antiinflammatories.
Since blood counts are monitored routinely these days in both outpatient and. Druginduced neutropenia is a potentially serious and lifethreatening adverse event that may occur secondary to therapy with a variety of agents. But the management of nonchemotherapy drug induced neutropenia is not as clearly outlined. The required prescription drugs is are not in the patients best interest because it. Druginduced thrombocytopenia is the most common druginduced hematologic disorders, with some reports suggesting that as many as 5% of patients who receive heparin develop heparininduced thrombocytopenia. Fever in a patient with neutropenia due to chemotherapy, hct, or bone marrow suppression from any cause is a medical emergency because such patients are at risk of sepsis and death from overwhelming infection. Absolute neutrophil count an overview sciencedirect topics. Severe and lifethreatening bone marrow suppression, resulting in neutropenia, thrombocytopenia, and anemia is the dose limiting toxicity of topotecan, observed in approximately 50%75% of patients across clinical trials. I am summarizing some of the key points in this post.
Druginduced hematological disorders can span almost the entire spectrum of hematology, affectingred cells, white cells, platelets, and the coagulation system 1. Nonsteroidal antiinflammatory drugs and neutropenia jama. Click on the drug to find more information including the brand names,dose,sideeffects, adverse events, when to. Current knowledge and clinical implications clozapine is an atypical antipsychotic that is effective in treatment resistant schizophrenia. In some cases, people only learn they have neutropenia when they have a blood test for an unrelated reason. Another area of active research has been identifying the risk factors and mechanism of druginduced neutropenia. A case of chronic druginduced neutropenia khan, ahsan y. Drug induced hematological disorders can span almost the entire spectrum of hematology, affectingred cells, white cells, platelets, and the coagulation system 1. Cytotoxic chemotherapy can cause a predictable and doserelated decrease in neutrophil count. The highest risk categories are antithyroid medications, macrolides, and procainamides.
Nonchemotherapy druginduced agranulocytosis annals of. The association between nonsteroidal antiinflammatory drugs nsaids and neutropenia is based primarily on case reports only. An international journal of medicine 1105 january 2017 with 74 reads how we measure reads. The clinical data of 30 caucasian patients followed up for antithyroid druginduced neutropenia at a thirdlevel hospital are reported. Due to the technical difficulties of detecting antibodies to neutrophils. Druginduced neutropenia with absolute neutrophil counts of less than 1500l has been observed during treatment with most secondgeneration antipsychotics clozapine, olanzapine, risperidone, and quetiapine and mood stabilizers carbamazepine, valproic acid, and lamotrigine. The glutamatergic antagonist riluzole was approved in 1995 for the management of als and has become its standard therapy. Druginduced neutropenia pathophysiology, clinical features. Nonchemotherapy druginduced neutropenia and agranulocytosis. Sepsis and persisting neutropenia in a drug addict. Druginduced neutropenia was first reported by kracke in 1931, attributed to.
In such cases, medical or drug policy criteria are not applied. Severe neutropenia is characterized by a profound decrease of circulating neutrophils in case of an. Management of chemotherapyinduced neutropenia with. Depending on the severity of neutropenia, patients are at a risk for developing various infections. A populationbased, casecontrol study was performed with medicaid claims data from six states. As the immunological mechanisms, opsonizing neutrophils, neutrophil cytotoxicity and neutrophil agglutination by antineutrophil antibodies have been documented 14. A thorough laboratory workup and a detailed patient. Peter manu, in goldmans cecil medicine twenty fourth edition, 2012. Druginduced neutropenia is one of many idiosyncratic drug reactions idr that target skin, liver, bone marrow, peripheral blood cells and other organs and which, together, are a major cause of morbidity and mortality in developed countries. Many drugs or their metabolites are directly toxic to bone marrow and thus inhibit the production of neutrophils. Important goals during preclinical drug development is to predict whether a new agent will be clinically toxic to the bone marrow, whether the toxicity will be specific to one cell lineage lymphocytes, neutrophils, megakaryocytes, or erythrocytes, at what dose or plasma level the drug will be toxic, which model best predicts the clinical.
Pdf on may 1, 2000, h g munshi and others published severe. Drug induced neutropenia is a potentially serious and lifethreatening adverse event that may occur secondary to therapy with a variety of agents. Druginduced neutropenia is characterized by a decline in absolute neutrophil counts precipitated by exposure to a medication. It is associated with considerable morbidity and mortality, as. May 11, 2004 the glutamatergic antagonist riluzole was approved in 1995 for the management of als and has become its standard therapy. Below is a list of common medications used to treat or reduce the symptoms of druginduced neutropenia. A thorough laboratory workup and a detailed patient history to. Pdf on aug 10, 2019, ananya gupta and others published management of chemotherapy induced neutropenia an unmet clinical need find, read and cite all the research you need on researchgate. How to approach druginduced agranulocytosis in icu mahant s. Drug induced neutropenia accounts for more than 70% of all neutropenias encountered in clinical practice. Severe neutropenia is defined as an absolute neutrophil count anc of fewer than 500mcl 0. To examine the rate, risks factors, and consequences of neutropenia induced by intravenous iv biologic diseasemodifying antirheumatic drugs bdmard. 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.
Rheumatoid arthritis ra was the most frequent diagnosis 72. Others causes of acquired neutropenia, such as primary immune mechanisms, chemotherapy, and infections, as well as congenital neutropenia in children are discussed separately. Drug induced thrombocytopenia is the most common drug induced hematologic disorders, with some reports suggesting that as many as 5% of patients who receive heparin develop heparin induced thrombocytopenia. Below is a list of common medications used to treat or reduce the symptoms of drug induced neutropenia. Neutropenia itself is a rare entity, but can be clinically common in oncology and immunocompromised individuals as a result of chemotherapy drug induced neutropenia. Druginduced neutropenia is a potentially lifethreatening complication that may be seen after the use of numerous drugs, including antipsychotics, antibiotics, antithyroid agents, but most importantly, chemotherapeutic drugs. The most important series devoted to antithyroid drug induced severe neutropenia and agranulocytosis are japanese studies, almost specifically in relation to the intake of methimazole. As stated above, many drugs act by an immunemediated. Neutropenia is an extremely rare, not welldescribed, lifethreatening adverse reaction of the drug. Listed below are some drugs that may cause neutropenia neutrophil count pdf on aug 10, 2019, ananya gupta and others published management of chemotherapy induced neutropenia an unmet clinical need find, read and cite all the research you need on researchgate.
Neutropenia is a low level of a form of white blood cells. Click on the drug to find more information including the brand names,dose,sideeffects, adverse events, when to take the drug. Nonchemotherapy idiosyncratic drug induced neutropenia idin is a relatively rare but potentially fatal disorder that occurs in susceptible individuals, with an incidence of 2. Nonsteroidal antiinflammatory drugs and neutropenia. A complete list of drugrelated agranulocytosis case reports can be found at. Udenyca prevention of chemotherapyinduced neutropenia. Reduction of the duration of neutropenia and neutropenia related clinical sequelae e. Follow the links to read common uses, side effects, dosage details and. Let us text you a link to download our free android or iphone app. The management of chemotherapyinduced neutropenia and chemotherapyinduced neutropenia with fever are presented separately. Idiosyncratic druginduced neutropenia and agranulocytosis is seldom discussed in the literature, especially for new drugs such as biotherapies outside the context of oncology. The drug is typically administered once daily until neutrophil recovery when it is utilized for neutropenia prophylaxis in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy. Neutropenia itself is a rare entity, but can be clinically common in oncology and immunocompromised individuals as a result of chemotherapy druginduced neutropenia.
A literature search was performed via the pubmed database of the us national library of medicine. Druginduced neutropenia is caused by a variety of mechanisms, including direct toxic effects and immunological reactions. Many drugs can cause agranulocytosis and neutropenia by bone marrow. Neutropenia secondary to other medications tends to be an idiosyncratic reaction either as an immune.
The data of 30 patients with idiosyncratic antithyroid. Because pharmacokinetic differences across species may contribute to as much as a 4fold difference in mtd, and the prediction model does not accommodate this. An abnormally low level of neutrophils in the circulating blood. Full prescribing information food and drug administration. Neutropenia in pediatric practice american academy of. Vancomycin has been used for a long time to manage resistant grampositive bacterial infections. Medications such as clozapine, trimethoprimsulfamethoxazole and methimazole have been more commonly associated with agranulocytosis than other agents. List of drugs used to treat the medical condition called neutropenia. The range of drugs capable causing idrs seems almost limitless, although certain agents are far more. No transfusion free period greater than 35 days in the previous 24 weeks e. Application of the cfugm assay to predict acute druginduced. Drug induced neutropenia is one of many idiosyncratic drug reactions idr that target skin, liver, bone marrow, peripheral blood cells and other organs and which, together, are a major cause of morbidity and mortality in developed countries. Understanding idiosyncratic druginduced neutropenia kessenich, cathy r.
List of drugsmedicine used for neutropenia understanding. We searched for articles published between january 2010 and july 2019 using the following key words or associations. Druginduced neutropenia accounts for more than 70% of all neutropenias encountered in clinical practice. Cases were defined as patients hospitalized with neutropenia. Stroncek a large number of drugs have been found to cause neutropenia. We conducted a retrospective cohort study in 499 patients with rheumatic diseases treated by iv abatacept aba, infliximab ifx, or tocilizumab tcz. Clozapine, agranulocytosis, and benign ethnic neutropenia. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may. Drug induced neutropenia is a potentially lifethreatening complication that may be seen after the use of numerous drugs, including antipsychotics, antibiotics, antithyroid agents, but most importantly, chemotherapeutic drugs. Additionally, acute neutropenia can be commonly seen from people recovering from a viral infection or in a postviral state. Application of the cfugm assay to predict acute drug. Filgrastim, filgrastimsndz, tbofilgrastim monograph for.
Chemotherapyinduced febrile neutropenia is a medical emergency complicating the treatment of many cancer patients. Compare prices and find information about prescription drugs used to treat neutropenia. Druginduced neutropenia and agranulocytosis uptodate. Listed below are some drugs that may cause neutropenia.
Nonchemotherapy druginduced agranulocytosis is a rare adverse reaction that is characterized by a decrease in peripheral neutrophil count to less than 0. Let us text you a link to download our free android. The clinical data of 30 caucasian patients followed up for antithyroid drug induced neutropenia at a thirdlevel hospital are reported. Another area of active research has been identifying the risk factors and mechanism of drug induced neutropenia.
Understanding idiosyncratic druginduced neutropenia. Druginduced thrombocytopenia is the most common druginduced hematologic disorder, with reports suggesting that between 0. Druginduced neutropenia can occur in association with various analgesics, psychotropics, anticonvulsants, antithyroiddrugs, antihistaminics, nonsteroidal antiinflammatories. Idiosyncratic drug induced neutropenia and agranulocytosis is seldom discussed in the literature, especially for new drugs such as biotherapies outside the context of oncology. Idiopathic, immune, infectious, and idiosyncratic neutropenias. Free, official information about 2014 and also 2015 icd9cm diagnosis code 288. In the present paper, we report and discuss the clinical data and management of this relatively rare disorder, with a focus on biotherapies used in autoimmune and autoinflammatory diseases. Only one case of reversible neutropenia associated with an inadvertent. Neutropenia can be graded as mild, moderate, and severe, corresponding respectively to anc. Chemotherapy drug induced neutropenia has a very high incidence in oncology patients. Reduction of the duration of neutropenia and neutropeniarelated clinical sequelae e. Neutropenia is an uncommon and potentially serious adverse effect associated with vancomycin use.