Drug-induced thrombocytopenia

• Typical onset 5 to 10 days after drug administration
  • Nadir of less than 20
  • A severe form is heparin-induced thrombocytopenia, discussed elsewhere
  • Counts usually start to recover after 4 or 5 half-lives of the offending medication
• IVIG can be given in severe thrombocytopenia
• Drugs associated with non-immune thrombocytopenia
  • Impaired thrombopoiesis: chemotherapy, interferon-alpha, linezolid, botrezomib, thiazide diuretics, ethanol, tolbutamid, ganciclovir
  • Platelet apoptosis: tamoxifen, navitoclax, methotrexate, nuclear factor-kB inhibitors, lovastatin, doxorubicin, bexarotene, arsenic trioxide, aspirin, vancomycin, trifluoperazine, balhimycin, carmustine, cisplatin
• Other drugs:
  • Quinine, sulfonamide, NSAIDs
  • Penicillin, some cephalosporins
  • Tirofiban, eptifibatide
  • Abciximab
  • Gold salts, procainamide
  • Heparin, protamine