Medications Induced Neutropenia: Avoid them with Clozapine.

Neutropenia is the single most important risk factor for infection and Clozapine is well known for the increased for neutropenia. This neutropenia risk will increase if clozapine is combined with another medication with similar risk. 

Which of the following non-psychiatric medications is known for the risk of neutropenia and hence should be avoided with clozapine?

  • (a) Hydralazine
  • (b) Propylthiouracil
  • (c) Cephalosporins
  • (d) Indomethacin
  • (e) All of the above
  • (f) None of the above

Answer: (e) All of the above

Here is the list of non-psychiatric medications with the risk of inducing neutropenia:

Analgesic/Anti-Inflammatory medications:

  • Aminopyrine
  • Ibuprofen
  • Indomethacin
  • Phenylbutazone

Antimicrobials:

  • Cephalosporins
  • Penicillin
  • Sulfonamides

Thyroid medications:

  • Prophylthiouracil
  • Methimazole

Cardiovascular medications:

  • Hydralazine
  • Procainamide
  • Quinidine

References:

  • J Lab Clin Med. 1999 Jan;133(1):15-22. (pubmed)
  • Hematology Am Soc Hematol Educ Program. 2017;2017(1):187-193. (PDF)
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