Non-chemotherapy drug-induced agranulocytosis

Author: Garbe, Edeltraut

Source: Expert Opinion on Drug Safety, Volume 6, Number 3, May 2007 , pp. 323-335(13)

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Abstract:

Acute agranulocytosis is a rare, potentially life-threatening condition, which is attributable to drugs in > 70% of cases. Agranulocytosis is characterised by a peripheral neutrophil count < 0.5 × 10⁹/l. It often manifests with a severe sore throat, but isolated fever, pneumonia or septicaemia are not uncommon. Agranulocytosis may be caused by many drugs. High-risk drugs include antithyroid drugs, clozapine, ticlopidine, sulfasalazine, dipyrone, trimethoprim/sulfamethoxazole, carbamazepine and probably rituximab. Suspect drugs should be stopped immediately. In febrile patients, blood cultures and, where indicated, site-specific cultures should be obtained and treatment with empirical broad spectrum antibiotics started. Haematopoietic growth factors should be considered in patients with poor prognostic factors (e.g., a neutrophil count < 0.1 × 10⁹/l), severe clinical infection or severe underlying disease or comorbidity. Case fatality has decreased to ~ 5% in recent years, probably owing to improved intensive care treatment and increased alertness of physicians to this severe adverse reaction.

Keywords: adverse effects; agranulocytosis; drug-induced agranulocytosis; epidemiology; haematopoietic cell growth factors

Document Type: Research article

DOI: http://dx.doi.org/10.1517/14740338.6.3.323

Publication date: 2007-05-01

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