Psychotropic drug-induced neutropenia

Abstract

Psychotropic medications have been known to cause blood dyscrasias, including neutropenia, and since the advent of clozapine, this side effect is now increasingly being recognized. Almost all the major classes of psychotropic medications have been associated with neutropenia. Operational definitions for blood dyscrasias have allowed us to create an epidemiological database on this rare side effect of psychotropic medications. With increased awareness of drug-induced neutropenia among physicians, methods of early detection and treatment of this side effect have also been the focus of recent literature. Another area of active research has been identifying the risk factors and mechanism of drug-induced neutropenia. This article attempts to synthesize our current understanding of psychotropic drug-induced neutropenia and also provide insights into future research in this realm.

Haematological toxicity of drugs used in psychiatry

“…Some drugs cause bone marrow barbiturates and benzodiazepines are the most common causes of neutropenia and agranulocytosis. It is not widely appreciated that olanzapine has the third highest incidence of neutropenia amongst both typical and atypical antipsychotics (Duggal and Singh, 2005). Other drugs that are well-recognised causes of neutropenia include antiepileptics/mood stabilisers (notably carbamazepine, risk of neutropenia approxi- (Oyesanmi et al, 1999).…”

“…However, the ions may also either bind to neutrophils to cause cell death, or could cause oxidative stress-induced neutrophil apoptosis (Husain et al, 2006). It is possible that the target in agranulocytosis could be stromal cells, neutrophil precursors in the bone marrow (Pereira and Dean, 2006), in addition to mature peripheral neutrophils, whilst the main target in neutropenia may only be the peripheral blood neutrophils (Duggal and Singh, 2005).…”

“…In the main, the mechanisms underlying these disorders are poorly understood. Recent reviews of the subject are available (Duggal and Singh, 2005;Hall et al, 2003;Oyesanmi et al, 1999).…”

Management of Depression in Terminally Ill Patients – A Critical Review

“…Neutropenia is a one among the possible complication of the use of TCAs [39] mianserin [40] and mirtazapine [41] with data also for fluoxetine, trazodone, nefazodone, and sertraline [42]. Examination of white cell count is extremely important in cancer patients receiving chemotherapy.…”

“…Examination of white cell count is extremely important in cancer patients receiving chemotherapy. Patients with lung cancer often have dyspnea, anxiety, pain and, in about 25% of the cases, clinically significant depressive states [42]. Whereas, the use of ADs is not generally contraindicated, benzodiazepines should be generally avoided.…”