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Medication Causes of Neutropenia

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Medication Causes of Neutropenia, Neutropenia due to Medication, Drug-Induced Neutropenia, Drug-Induced Agranulocytosis

  • See Also
  1. Neutropenia
  2. Neutropenia Causes
  3. Chemotherapy-Induced Neutropenia
  • Epidemiology
  1. Incidence 2.4 to 15.4 cases per 1 million adults/year
  • Pathophysiology
  1. Neutropenia is defined as ANC <1500/uL (<1000/uL in age <1 year)
  2. Drugs are second most common cause of Neutropenia
  3. Induce hypoproliferation via marrow injury
  • Findings
  1. See Chemotherapy-Induced Neutropenia
  2. Idiosyncratic Drug-Induced Neutropenia
    1. Unrelated to direct Neutropenia causing agents (e.g. Chemotherapy, Biologic Agents)
    2. Neutropenia onset within 7 days of drug exposure
    3. Resolution is typical within 1 month of medication discontinuation
      1. Neutropenia often recurrs with accidental reexposure (not recommended)
  3. Exclude other causes
    1. Pancytopenia (associated Anemia or Thrombocytopenia)
    2. Recent infection (e.g. Mononucleosis, HIV Infection, Viral Hepatitis)
    3. Chronic Neutropenia Causes
  • Causes
  • Most common
  1. Chemotherapy-Induced Neutropenia
  2. Thyroid inhibitors (Antithyroid Drugs)
  3. Trimethoprim-Sulfamethoxazole (Septra, Bactrim)
  4. Sulfasalazine
  5. Clomipramine
  6. Dipyrone
  7. Concurrent Analgesic use is predisposing factor
  1. See Chemotherapy-Induced Neutropenia
  2. See Alkylating Agents
  3. See Antimetabolite Chemotherapy
  4. Anthracyclines (e.g. Doxorubicin, Daunorubicin)
  5. Taxanes (e.g. Paclitaxel, Docetaxel)
  6. Topoisomerase Inhibitors (Etoposide)
  7. Platinum Chemotherapy (e.g. Cisplatin)
  8. Gemcitabine (Gemzar)
  9. Vinorelbine (Navelbine)
  • Causes
  • Antimicrobials
  1. Penicillins and Cephalosporins (esp. Amoxicillin)
  2. Chloramphenicol
  3. Vancomycin
  4. Sulfonamide (trimethoprim-sulfamethoxazole)
  5. Gentamicin
  6. Clindamycin
  7. Doxycycline
  8. Minocycline
  9. Metronidazole
  10. Nitrofurantoin
  11. Rifampin
  12. Isoniazid
  13. Ethambutol
  14. Streptomycin
  15. Dapsone
  16. Ciprofloxacin
  17. Antimalarial medications (e.g. Chloroquine)
  18. Mebendazole
  19. Terbinafine
  20. Griseofulvin
  • Causes
  • Neuropsychotropics
  1. Antipsychotics
    1. Phenothiazine (e.g. Chlorpromazine)
    2. Risperidone (Risperdal)
    3. Clozapine (Clozaril)
    4. Haloperidol (Haldol)
    5. Olanzapine (Zyprexa)
    6. Quetiapine (Seroquel)
    7. Ziprasidone
    8. Thiothixene (Navane)
  2. Sedative-Hypnotics
    1. Barbiturates
    2. Meprobamate
  3. Antidepressants
    1. Imipramine or Desipramine
  4. Antiepileptics
    1. Valproic Acid (Depakote)
    2. Phenytoin (Dilantin)
    3. Carbamazepine (Tegretol)
    4. Ethosuximide (Zarontin)
  • Causes
  • Cardiovascular Medications
  1. Antiarrhythmics
    1. Procainamide
    2. Quinidine
    3. Propafenone
    4. Amiodarone
    5. Digoxin
  2. Antihypertensives
    1. Lisinopril
    2. Ramipril
    3. Captopril
    4. Propranolol
    5. Hydralazine
    6. Methyldopa
    7. Furosemide
    8. Spironolactone
    9. Torsemide
    10. Thiazide Diuretics
    11. Propranolol
    12. Nifedipine
  3. Antiplatelet
    1. Clopidogrel
    2. Ticlopidine
  1. NSAIDs (Ibuprofen, Indomethacin, Sulindac, Tolmetin)
  2. Acetylsalicylic Acid (Aspirin)
  • Causes
  • Miscellaneous
  1. Acetazolamide
  2. Allopurinol
  3. Colchicine
  4. Antithyroid Drugs (e.g. Propylthiouracil)
  5. Antihistamines (e.g. Cimetidine, Brompheniramine)
  6. Quinine
  7. Levodopa
  8. Heavy Metals
    1. Gold
    2. Arsenic
    3. Mercury
  • Management
  1. Stop causative medications (and avoid reexposure)
  2. Hospitalization and broad spectrum Antibiotics for ANC <200/uL (Agranulocytosis)
  3. Follow weekly CBC until resolution
  • References
  1. Lee (1999) Wintrobe's Hematology, Lippincott, p. 1862-9
  2. Kim (2025) Am Fam Physician 112(6): 618-28 [PubMed]
  3. van der Klauw (1999) Arch Intern Med 159(4):369-74 [PubMed]