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From Medicineworld.org: Drugs causing neutropenia or agranulocytosis


Drugs causing agranulocytosis or low white cell count

Many drugs can cause agranulocytosis and neutropenia. The mechanism of neutropenia can be varied depending on the drug. Many anti- neoplastic drugs cause agranulocytosis and neutropenia by bone marrow suppression. Neutropenia and agranulocytosis can also result from antibody or compliment mediated damage to the stem cells. Some drugs may cause increased peripheral destruction of white cells. About three fourth of all agranulocytosis in the United States is related to drugs. Procainamide, anti-thyroid drugs and sulfasalazine are at the top of the list of drugs causing this problem. Most agranulocytosis is related to the direct effect related to its dose. Phenothiazines, semi-synthetic penicillins, non-steroidal anti-inflammatory drugs (NSAIDs), aminopyrine derivatives, benzodiazepines, barbiturate, gold compounds, sulfonamides, and anti-thyroid medications are the most common causes of neutropenia and agranulocytosis. The neutropenia manifests in about one two weeks after exposure to these drugs. Degree of neutropenia depends upon the dose and duration of exposure. Recovery usually occurs within few days of stopping the drug. The marrow recovery may take 10 to 14 days. Some time a rebound leukocytosis may occur. If the neutropenia is not very severe and the medication is an essential drug for the patient, some times the drug may be continued with under close monitoring. As long as absolute neutrophil count is above 500 to 700 and there is no active infection the drug may be continued if needed. If a bone marrow biopsy is done and it shows cellular bone marrow this might suggest peripheral destruction of white cells and this may be clinically less relevant.

List of drugs that causes agranulocytosis or neutropenia sorted as per probability
(Anti-neoplastic drugs are not included)
  • Dipyrone
  • Mianserin
  • Sulfasalazine
  • Co-trimoxazole
  • Anti-arrythmic agents
    • Procainamide
    • Ajmaline
    • Tocainide
    • Aprindine
    • Amiodarone
  • Penicillins
    • Amoxycillin
    • Aziocillin
    • Benzylpenicillin
    • Phenethicillin
    • Cloaxacillin and penicillin
  • Thiouracil derivatives
    • Methyl thiouracil
    • Propyl thiourcil
  • Phenylbutazone
  • Cimetidine
  • Penicillamine
  • Diclofenac
  • Carbamazepine
  • ACE-Inhibitors
    • Captopril
    • Enalapril
  • Hydrochlorothiazide with potassium sparing diuretics
  • Indomethacine
  • Cephalosporins
    • Cephalexin
    • Cepahazolin
    • Cefuroxime
    • Cefitaxime
    • Cephradine
  • Oxyphenbutazone
  • Nitrofurantoin
  • Salicylic acid derivatives
  • Clozapine
  • Carbimazone
  • Sulphonylurea derivatives
    • Glibenclamide
    • Tolbutamide
  • Methyldopa
  • Thiamazole
  • Nucleosides
  • Aminoglutethimide
  • Ibuprofen
  • Pentazocine
  • Levamizole
  • Promethazine
  • Chloramphinicol
  • Acetaminophen and combinations
  • Perazine
  • Mebhydrolin
  • Ranitidine
  • Imipramine
  • Miscellaneous drugs (relatively lower probability)
    • Phenytoin
    • Chlorthalidone
    • Sulphamethizole
    • Norfloxacin
    • Naproxen
    • Clomipramine
    • Trazodone
    • Omeprazole
    • Alimemazine
    • Pirenzepine
    • Ticlopidine
    • Ibopamine
    • Hydralazine
    • Nifedipine
    • Nalidixic acid
    • Doxycycline
    • Clindamycin
    • Gentamycin
    • Fusidic acid
    • Dapsone
    • Azapropazone
    • Propyphenazone
    • Sulindac
    • Piroxicam
    • Pirprofen
    • Niflumic acid
    • Allopurinol
    • Glafenine
    • Valproate
    • Levadopa with carbidopa
    • Chlorpramazine
    • Haloperidol
    • spironolactone
    • Zuclopenthixol
    • Zopiclone
    • Cinnarizine
    • Metronidazole
    • Pyrimethamine combinations
    • Thophylline

Did you know?
Many drugs can cause agranulocytosis and neutropenia. The mechanism of neutropenia can be varied depending on the drug. Many anti- neoplastic drugs cause agranulocytosis and neutropenia by bone marrow suppression. Neutropenia and agranulocytosis can also result from antibody or compliment mediated damage to the stem cells. Some drugs may cause increased peripheral destruction of white cells. About three fourth of all agranulocytosis in the United States is related to drugs.

Medicineworld.org: Drugs causing neutropenia or agranulocytosis

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