pharmaceutical agents implicated in neutropenia

Etiology

• increased destruction/ peripheral margination
  • aminopyrine
  • alpha-methyldopa
  • phenylbutazone
  • mercurial diuretics
  • phenothiazines (some)
• decreased production
  • antibiotics
    • chloramphenicol
    • penicillin, penicillins (amoxicillin)
    • sulfonamides
      • trimethoprim/sulfamethoxazole
    • cephalosporins
      • cefazolin
      • cephalexin
      • cefotaxime
      • cefuroxime
      • cephalothin
    • vancomycin
  • antiviral drugs
    • zidovudine
    • gancyclovir
  • antipsychotics
    • phenothiazines
    • clozapine
  • diuretics, hydrochlorothiazide
  • anti-thyroid drugs
    • propylthiouracil
    • methimazole
    • carbimazole
  • anti-inflammatory agents
    • gold salts
    • NSAIDs
      • indomethacin
      • naproxen
      • diclofenac
      • phenylbutazone
    • penicillamine
    • hydroxychloroquine
    • sulfasalazine
  • anticonvulsants
    • carbamazepine
    • valproic acid
    • phenytoin (diphenylhydantoin)
  • ranitidine
  • cytotoxic agents, antineoplastic agents
  • others, many including but not limited to
    • sulfonylureas- tolbutamide
    • ACE inhibitors (captopril)
    • tricyclic antidepressants
    • procainamide
    • aminosalicylate
    • quinine
• mechanism not known
  • antibiotics
    • clindamycin
    • norfloxacin
    • metronidazole
  • amiodarone
  • H2 receptor blockers
    • cimeticine
    • ranitidine

Epidemiology

• most often occurs in patients > 50 years during the 1st 3 months of treatment
• symptoms unsually improve within 1-3 weeks of stopping medication

Additional terms

• neutropenia