Metamizole Related Granulocytopenia and Agranulocytosis: An Analysis of 13 Children (original) (raw)
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Severe Sepsis Due to Cervical Abscess After Agranulocytosis Associated With Metamizole
Cirugía Española (english Edition), 2015
Sepsis grave por absceso cervical profundo tras agranulocitosis por metamizol Metamizole is the second most widely used analgesic in Spain 1 and rarely causes agranulocytosis (<10 000), 2 which is potentially fatal. We present a case of agranulocytosis associated with metamizole that led to the later development of deep cervical abscesses, which were treated with vacuum-assisted closure (VAC) therapy.
European Journal of Clinical Pharmacology, 2015
Purpose In 1986, the risk of agranulocytosis prompted German authorities to restrict the indications for metamizole use. After an initial decline, prescriptions increased from <20 million defined daily doses in 1990 to >140 million in 2012. Concurrently, spontaneous reports of agranulocytosis increased from about 10 in 1990 to >50 in 2012. In this study, reports were analyzed to identify targets for risk minimization measures. Methods Reports of suspected metamizole-induced agranulocytosis (neutrophils <0.5×10 9 cells/l) between 1990 and 2012 were identified in the German spontaneous reporting database. Cases for which original reporting documents were available were eligible for analysis. Patient characteristics, indication, clinical course, and outcome were assessed. Results One hundred sixty-one reports were analyzed. The mean age of the patients was 56.8 years (11-93) and 64.6 % were female. Off-label use was identified in about 25 % of cases. Neutrophils fell below 100/μl in 63 and intercurrent infections developed in 109 cases. Thirty-eight patients (23.6 %) died. In two thirds of the cases, agranulocytosis occurred within 6 weeks of permanent or intermittent metamizole treatment, in 30.5 % within 7 days, including 18 cases of immediate onset after the first or second administration. Conclusion The reported cases show severe clinical courses and are, to some extent, a result of off-label use. Due to the absence of individual risk factors and presence of variable onset patterns, risk minimization measures should focus on restricting use to defined clinical situations and providing concise risk information for patients and healthcare professionals.
Expert Opinion on Drug Safety, 2008
More than several hundred drugs, toxins, and herbs have been reported to cause blood abnormalities, and drugs account for 20 - 40% of all instances of cytopenias. In the present paper, we report and discuss the recognition and the management of drug-induced acute neutropenia or agranulocytosis (neutrophil count of &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.5 x 10(9)/l). A bibliographic search was performed on the PubMed database of the US National Library of Medicine for articles published from January 1990 to January 2008. Additional not published data of our cohort of drug-induced agranulocytosis in the University Hospital of Strasbourg, France were incorporated in this review. Idiosyncratic drug-induced acute neutropenia or agranulocytosis is a serious adverse event due to the frequency of severe infections (such as deep infections, septicemia and septic shock) but modern management with broad spectrum antibiotics and hematopoietic growth factors is likely to improve the prognosis. Given the increased life expectancy, increasing use of medications as a therapeutic modality and subsequent longer exposure to drugs, as well as the development of new agents, healthcare professionals should be aware of this adverse event and its management.
Update on the Incidence of Metamizole Sodium-Induced Blood Dyscrasias in Poland
Journal of International Medical Research, 2010
Poland. Controversy exists regarding the level of risk of agranulocytosis or aplastic anaemia associated with its use. Two previous pharmacovigilance studies conducted in Poland found the risk was low. Twenty-four of the 25 haematology centres that provide specialist care for the 30 million adults in Poland participated in this prospective 12-month study. Twentyone cases of agranulocytosis, 48 of aplastic anaemia, 15 of neutropenia and 11 of pancytopenia were reported. Of these cases, three (two agranulocytosis; one aplastic anaemia) were judged as being possibly related to metamizole. Crude estimates of the rate of agranulocytosis and aplastic anaemia associated with metamizole were 0.16 and 0.08 cases/million person-days of use, respectively. Ongoing national safety surveillance in Poland shows that, despite the possibility of drug-induced blood dyscrasias with metamizole, the risk is very low.
Agranulocytosis associated with dipyrone (metamizol)
European journal of clinical pharmacology, 2005
Reported estimates of the risk of agranulocytosis associated with metamizol have varied by several orders of magnitude. We assessed this association in a large database for the surveillance of blood dyscrasias. Since 1980, all laboratory units of haematology in a defined area (3.3-4.1x10(6) inhabitants) contribute to the ascertainment of all cases of agranulocytosis meeting strict diagnostic criteria. These cases of patients with agranulocytosis and sex-, age-, hospital- and date-matched controls were interviewed using a structured questionnaire about previous drug exposures, and relative risks were calculated for several categories of exposure to metamizol. After a total follow-up of 78.73x10(6) person-years, 273 community cases of agranulocytosis had been found--of which 96 were excluded for various reasons and 177 were included in the case-control analysis--and were compared with 586 matched controls. Thirty cases of agranulocytosis (16.9%) and nine controls (1.5%) had been expos...
The American Journal of Medicine, 2002
Objectives: A prospective evaluation of nonchemotherapy druginduced agranulocytosis (DIA) cases, which are infrequent in the pediatric population. We characterize agranulocytosis cases and assess lab test differences between drug-and nondrug-induced agranulocytosis. Methods: Through our Prospective Pharmacovigilance Program from Laboratory Signals at Hospital we detected pediatric agranulocytosis cases from July 2007 to December 2010. This program estimates the incidence, drug causality, clinical features, outcomes of DIA pediatric cases, and assesses laboratory differences with respect to non-DIA. Results: We detected 662 agranulocytosis in 308 pediatric patients, of which 14 were caused by nonchemotherapy drugs. The incidence rate of DIA for 10,000 pediatric patients was 3.92 (Poisson 95% confidence interval 1.09-8.77); 78.6% of DIA cases occurred in patients younger than 3 years. The final outcome was recovery without sequela in all cases. The pharmacologic group most frequently implicated was antimicrobial drugs (11 drugs), 7 of which were beta-lactams. The drugs most frequently suspected were cefotaxime and vancomycin (3 cases each). We found 3 drugs (cloperastine, codeine, and enoxaparin) not previously described to induce DIA. Automatic linear modeling (n = 56, R 2 = 45.2%) showed a significant inverse association with platelets (R 2 = 17.5%), hemoglobin, and alanine transaminase, and a direct association with red cell distribution (R 2 = 16.2%). A generalized linear model (Type III, n = 1188; DIA, n = 86; likelihood ratio chi-squared = 156.16) retained eosinophils (p < .001), platelets (p < .001), total serum proteins (p < .001), and hemoglobin (p = .039). Conclusions: We found a higher incidence of DIA in children than previously described. Our findings also suggest an immune-mediated destruction or myeloid toxicity, possibly facilitated by an increase in drug exposure.
A CASE REPORT ON CARBIMAZOLE INDUCED AGRANULOCYTOSIS
Indo American Journal of Pharmaceutical Research,, 2022
Drug induced agranulocytosis is encountered in patients on anti-thyroid medications, ranging from mild forms to life threatening situations. Expeditious discontinuation of the offending drugs helps to resolve agranulocytosis. Various parametric values are evaluated to monitor the side effects of Carbimazole. One main parameter includes the evaluation of TLC (Total Leukocyte Count). In this case report we are going to emphasize carbimazole induced agranulocytosis. Clinicians should be extremely conscious about such events and complete blood count monitoring helps to circumvent such situations.
Cureus
This article has been corrected at the request of the author due to presence of an error in the Discussion section which was noticed by a reader. The second sentence of the first paragraph in the Discussion section has been corrected as the original version incorrectly referred to "side effects", when in reality they are "clinical features". Original (incorrect): The common side effects of carbimazole include fever (92%), sore throat (85%), painful mouth ulcer (15%), ulcer (8%), and reduced immune response making individuals prone to infections [3]. Corrected: The common clinical features of carbimazole induced agranulocytosis include fever (92%), sore throat (85%), painful mouth ulcer (15%), ulcer (8%), and reduced immune response making individuals prone to infections [3].