open access

Vol 8, No 3 (2011)
Other materials agreed with the Editors
Published online: 2011-10-20
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Hematological side effects of psychotropic agents — guidance for the practitioner

Tomasz Pawełczyk, Agnieszka Pawełczyk, Jolanta Rabe-Jabłońska
Psychiatria 2011;8(3):97-109.

open access

Vol 8, No 3 (2011)
Akademia "Psychiatrii"
Published online: 2011-10-20

Abstract

Hematopoietic side effects also known as blood dyscrasias are relatively rare adverse reactions of psychotropic medications. However, they may pose a serious threat to the patient’s life. The most common drug-induced dyscrasias include neutropenia and agranulocytosis, thrombocytopenia, eosinophilia, and aplastic anemia. All groups of drugs used in psychiatry may lead to the development of these disorders, one drug may be responsible for the development of various dyscrasias. Drugs with high potential for causing serious hematological side effects include: clozapine, phenothiazine antipsychotics, carbamazepine, valproic acid, mianserin and mirtazapine. Careful monitoring of haematological parameters is necessary while using these medications. It is also recommended to avoid combining drugs with the high-risk of inducing blood dyscrasias. The risk of agranulocytosis during clozapine therapy is estimated at about 0.8–1.0%. The diagnosis of drug-induced blood dyscrasias can be difficult for clinicians because these disorders often manifest as common symptoms such as weakness, fever, common cold, sore throat or dry cough. Therefore it is necessary to maintain high degree of vigilance on the symptoms of respiratory infections in patients treated with one of the drugs with known potential for causing blood dyscrasias. The treatment of choice of the serious hematological adverse reactions is immediate discontinuation of the drug responsible for causing the disorder. Treatment of drug-induced cytopenia consists of intravenous administration of recombinant granulocyte colony stimulating factor and wide spectrum antibiotics. The prognosis with early diagnosis and implementation of appropriate treatment is generally good. Symptoms withdraw within several days. However the development of life-threatening complications such as sepsis or intracranial bleeding is possible. The article describes the most prevalent blood dyscrasias and presents a review of literature concerning the risk of hematological disorders during treatment with different classes of psychotropic drugs.
Psychiatry 2011; 8, 3: 97–109

Abstract

Hematopoietic side effects also known as blood dyscrasias are relatively rare adverse reactions of psychotropic medications. However, they may pose a serious threat to the patient’s life. The most common drug-induced dyscrasias include neutropenia and agranulocytosis, thrombocytopenia, eosinophilia, and aplastic anemia. All groups of drugs used in psychiatry may lead to the development of these disorders, one drug may be responsible for the development of various dyscrasias. Drugs with high potential for causing serious hematological side effects include: clozapine, phenothiazine antipsychotics, carbamazepine, valproic acid, mianserin and mirtazapine. Careful monitoring of haematological parameters is necessary while using these medications. It is also recommended to avoid combining drugs with the high-risk of inducing blood dyscrasias. The risk of agranulocytosis during clozapine therapy is estimated at about 0.8–1.0%. The diagnosis of drug-induced blood dyscrasias can be difficult for clinicians because these disorders often manifest as common symptoms such as weakness, fever, common cold, sore throat or dry cough. Therefore it is necessary to maintain high degree of vigilance on the symptoms of respiratory infections in patients treated with one of the drugs with known potential for causing blood dyscrasias. The treatment of choice of the serious hematological adverse reactions is immediate discontinuation of the drug responsible for causing the disorder. Treatment of drug-induced cytopenia consists of intravenous administration of recombinant granulocyte colony stimulating factor and wide spectrum antibiotics. The prognosis with early diagnosis and implementation of appropriate treatment is generally good. Symptoms withdraw within several days. However the development of life-threatening complications such as sepsis or intracranial bleeding is possible. The article describes the most prevalent blood dyscrasias and presents a review of literature concerning the risk of hematological disorders during treatment with different classes of psychotropic drugs.
Psychiatry 2011; 8, 3: 97–109
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Keywords

psychopharmacothertapy; adverse drug reactions; blood dyscrasias; agranulocytosis; neutropenia; plastic anemia; thrombocytopenia; eosinophilia

About this article
Title

Hematological side effects of psychotropic agents — guidance for the practitioner

Journal

Psychiatria (Psychiatry)

Issue

Vol 8, No 3 (2011)

Article type

Other materials agreed with the Editors

Pages

97-109

Published online

2011-10-20

Bibliographic record

Psychiatria 2011;8(3):97-109.

Keywords

psychopharmacothertapy
adverse drug reactions
blood dyscrasias
agranulocytosis
neutropenia
plastic anemia
thrombocytopenia
eosinophilia

Authors

Tomasz Pawełczyk
Agnieszka Pawełczyk
Jolanta Rabe-Jabłońska

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