Drug-induced neutropenia, also known as drug-induced agranulocytosis, is a condition characterized by a severe decrease in the number of neutrophils, a type of white blood cell responsible for fighting bacterial infections. Various drugs have been associated with the development of drug-induced neutropenia, and the exact mechanism behind this condition can vary.
Thee potential mechanisms by which drugs can induce neutropenia are:
- Immune-Mediated Destruction: Some drugs can trigger an immune response that leads to the destruction of neutrophils. This immune-mediated destruction can occur through the formation of drug-specific antibodies or the activation of immune cells, resulting in the destruction of neutrophils.
- Bone Marrow Suppression: Certain drugs can directly suppress the bone marrow’s ability to produce neutrophils. The bone marrow is responsible for generating new blood cells, including neutrophils. When suppressed, neutrophil production decreases, leading to neutropenia.
- Alteration of Neutrophil Maturation: Drugs may interfere with the maturation process of neutrophils within the bone marrow, resulting in the production of immature or non-functional neutrophils. These immature neutrophils may not effectively combat infections, leading to neutropenia.
Reference Range: Normal: 2.0-7.5 x 10^9/L
Neutropenic: <1.5 x 10^9/L
Chemotherapy Drugs
Certain chemotherapeutic agents used to treat cancer can cause neutropenia ad a side effect, such as:
- Cyclophosphamide
- Methotrexate
- 5-fluorouracil
antibiotics
Some antibiotics, particularly cephalosporins (e.g., cefaclor, ceftriaxone), can cause neutropenia in some individuals.
Antipsychotics
Clozapine, an atypical antipsychotic used in the treatment of schizophrenia, has been associated with the development of neutropenia, particularly in the first few months of treatment.
Antithyroid Drugs
Drugs used to treat hyperthyroidism have been known to cause neutropenia in rare cases, such as:
- Methimazole
- Propylthiouracil
- Carbimazole (MHRA alert- carbimazole should be stopped promptly if neutropenia suspected)
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
Although uncommon, some NSAIDs, including ibuprofen, naproxen, and diclofenac, have been reported to cause neutropenia in certain individuals.
Anticonvulsant medications:
Some anticonvulsants such as:
- Valproic acid used to treat epilepsy and bipolar disorder, has been associated with neutropenia, particularly in children.
- Phenytoin
Immunomodulatory drugs
Certain immunomodulating medications used in the treatment of autoimmune diseases can lead to neutropenia as a potential side effect, such as:
- Methotrexate
- Azathioprine
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