Drug-induced neutropenia

• Agranulocytosis refers to the complete absence of neutrophils or granulocytes (ANC of 0)

Class	Drug	Frequency reported	Nature of reaction
Antibiotics	Semisynthetic penicillins (amoxicillin, ampicillin)	Moderate	Both
	Cephalosporins	Moderate	Both
	Vancomycin	High	Both
	Macrolides	Low	Neutropenia
	TMP-SMX	High	Agranulocytosis
	Dapsone	High	Agranulocytosis
	Chloramphenicol	High	Agranulocytosis
Antifungals	Amphotericin	Low	Neutropenia
	Flucytosine	Low	Agranulocytosis
Antimalarials	Chloroquine	Low	Agranulocytosis
	Quinine	Moderate	Agranulocytosis
Antiinflammatory agents	Ibuprofen	Low	Agranulocytosis
	Diclofenac	Moderate	Agranulocytosis
	Sulfasalazine	High	Agranulocytosis
	Gold salts		Agranulocytosis
Antithyroid drugs	Methimazole	High	Agranulocytosis
	Propylthiouracil	Moderate	Agranulocytosis
Psychotropic agents	Clozapine	High	Agranulocytosis
	Phenothiazines (chlorpromazine)	Moderate	Agranulocytosis
	Tricyclic agents (amitriptyline)	Low	Agranulocytosis
Antiepileptics	Carbamazepine	Low	Neutropenia
	Phenytoin	Moderate	Agranulocytosis
	Valproate	Low	Neutropenia
	Ethosuximide	Low	Neutropenia
Cardiovascular drugs	Antiarrhythmic agents (procainamide, flecainide)	High	Agranulocytosis
	ACE inhibitors	Moderate	Agranulocytosis
	Propranolol	Low	Agranulocytosis
	Digoxin	Moderate	Agranulocytosis
	Ticlopidine	High	Agranulocytosis
Diuretics	Thiazides	Low	Neutropenia
	Furosemide	Low	Neutropenia
	Spironolactone	Low	Agranulocytosis
	Acetazolamide	Low	Neutropenia
Other	Deferiprone	Moderate	Agranulocytosis
	Levamisole	Moderate	Agranulocytosis
	Rituximab	Moderate	Agranulocytosis

• From