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Stamp LK, Horsley C, Te Karu L, Dalbeth N, Barclay M. Colchicine: the good, the bad, the ugly and how to minimize the risks. Rheumatology (Oxford) 2024; 63:936-944. [PMID: 38019947 PMCID: PMC10986813 DOI: 10.1093/rheumatology/kead625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Colchicine has an important role in managing various conditions, including gout, familial Mediterranean fever, amyloidosis, Behçet's syndrome, recurrent pericarditis and calcium pyrophosphate deposition disease. The adverse effect profile of colchicine is well understood. However, due to its narrow therapeutic index, colchicine has been associated with overdose and fatalities. When ingested in toxic amounts, the mainstay of management is supportive care. Strategies to minimize the risk of colchicine poisoning can focus on three broad causes: unauthorized access, intentional overdose and inappropriate dosing. Culturally safe and appropriate education about storage and appropriate use of colchicine is essential to minimize the risk of overdose.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Carl Horsley
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand
| | - Leanne Te Karu
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Murray Barclay
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
- Department of Clinical Pharmacology, Te Whatu Ora, Waitaha Canterbury, New Zealand
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Spaetgens B, de Vries F, Driessen JHM, Leufkens HG, Souverein PC, Boonen A, van der Meer JWM, Joosten LAB. Risk of infections in patients with gout: a population-based cohort study. Sci Rep 2017; 7:1429. [PMID: 28469154 PMCID: PMC5431148 DOI: 10.1038/s41598-017-01588-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 12/24/2022] Open
Abstract
To investigate the risk of various types of infections (pneumonia and urinary tract infection (UTI)), and infection-related mortality in patients with gout compared with population-based controls. A retrospective cohort study was conducted using data from the UK Clinical Practice Research Datalink (CPRD). All patients with a first diagnosis of gout and aged >40 years between January 1987-July 2014, were included and matched with up to two controls. Time-varying Cox proportional hazards models were used to estimate the risk of infections and mortality. 131,565 patients and 252,763 controls (mean age: 64 years, 74% males, mean follow-up of 6.7 years) were included in the full cohort. After full statistical adjustment, the risk of pneumonia was increased (adj. HR 1.27, 95% CI 1.18 to 1.36), while the risk of UTI (adj. HR 0.99, 95% CI 0.97 to 1.01) was similar in patients compared to controls. No differences between patients and controls were observed for infection-related mortality due to pneumonia (adj. HR 1.03, 95% CI 0.93 to 1.14) or UTI (adj. HR 1.16, 95% CI 0.98 to 1.37). In conclusion, patients with gout did not have decreased risks of pneumonia, UTI or infection-related mortality compared to population-based controls.
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Affiliation(s)
- B Spaetgens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Internal medicine and Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - F de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - J H M Driessen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H G Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - P C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Boonen
- Department of Internal medicine and Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - J W M van der Meer
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L A B Joosten
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, The Netherlands
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Ataş B, Caksen H, Tuncer O, Kirimi E, Akgün C, Odabaş D. Four children with colchicine poisoning. Hum Exp Toxicol 2016; 23:353-6. [PMID: 15311853 DOI: 10.1191/0960327104ht457sc] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Colchicine poisoning is a rare event. It is characterized by multiorgan involvement and by poor prognosis associated with overdose. In this article we present four children with colchicine poisoning to emphasize that colchicine poisoning has a large spectrum in childhood. The children's ages ranged between 1 year and 3.5 years. The ingested dosage of colchicine was between 0.37 and 1.72 mg/kg. Most of the findings of colchicine poisoning such as gastrointestinal symptoms, hepatotoxicity, cardiotoxicity, bone marrow suppression, hypocalcaemia and hair loss were diagnosed in our patients. Two children receiving 0.37 mg/kg and 1 mg/kg colchicine and admitted 13 and 19 hours after poisoning, respectively, died. Our findings suggest that in addition to amounts of the drug, mortality was also related to the duration between drug ingestion and admission to hospital.
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Affiliation(s)
- Bülent Ataş
- Department of Pediatrics, Faculty of Medicine, Yüzüncü Yil University, Van, Turkey.
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Ozdemir R, Bayrakci B, Teksam O. Fatal poisoning in children: acute colchicine intoxication and new treatment approaches. Clin Toxicol (Phila) 2011; 49:739-43. [PMID: 21910646 DOI: 10.3109/15563650.2011.610146] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Colchicine poisoning is potentially life-threatening. Deaths generally result from hypovolemic shock and cardiovascular collapse or secondary to rapidly progressive multiorgan failure. OBJECTIVE The purpose of this study is to discuss the clinical effects, treatments and outcomes of pediatric colchicine poisoning and highlight the possible benefits of urgent plasma and whole blood exchange therapy for those patients who were believed to ingest potentially lethal doses of the drug. METHODS Current study was designed as an observational case series study. The medical records of children aged 0-16 years who were hospitalized for colchicine poisoning at the Pediatric Intensive Care Unit of, between November 1985 and March 2011 were retrospectively evaluated. RESULTS We present twenty-three children with colchicine poisoning. Nausea and vomiting were the most common presenting complaint, in 70% of patients. Sixteen of the 23 cases presented after ingesting sub-toxic doses of colchicine (< 0.5 mg/kg), whereas 3 patients had consumed toxic doses of the drug (0.5-0.8 mg/kg). The remaining 4 patients were hospitalized after taking colchicine at a lethal dose (> 0.8 mg/kg). Three patients (13%) died. CONCLUSIONS Any patient suspected of ingesting high doses of colchicine should prompt immediate fluid and electrolyte resuscitation and invasive hemodynamic monitorization in a pediatric intensive care unit. Although there is lack of strong evidence, early initiation of either whole blood or plasma exchange may be considered in patients presenting with lethal-dose colchicine intoxication. These reported experience of us put forth further research for consideration.
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Affiliation(s)
- Ramazan Ozdemir
- Zekai Tahir Burak Maternity Teaching Hospital, Neonatal Intensive Care Unit, Ankara, Turkey.
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Fagan NL, Wear RE, Malesker MA, Morrow LE, Schuller D. Colchicine Overdose—The Need for a Specific Antidote. Hosp Pharm 2010. [DOI: 10.1310/hpj4501-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To report the case of a colchicine overdose to highlight current limitations in the treatment of this toxicologic emergency. Summary A 23-year-old man was admitted to the intensive care unit (ICU) after attempting suicide via polypharmacy ingestion, which included 80 to 100 colchicine 0.6 mg tablets (approximately 0.9 mg/kg of body weight). He was taken to the emergency department where gastric decontamination was initiated. Because attempts to obtain a colchicine-specific antibody fragment (Fab) were unsuccessful, only supportive therapies were provided throughout his hospitalization. Over the course of several days, the patient experienced the 3 separate evolutionary phases of colchicine toxicity ultimately leading to multiple organ failure and hemodynamic collapse, and death. Conclusion Acute colchicine intoxication is a rare, but potentially life-threatening event. Although 1 case report demonstrated the successful use of a colchicine-specific Fab fragment in the management of acute colchicine overdose, there is presently no commercially-available antidote for colchicine toxicity. Prompt recognition of the overdose, aggressive gastrointestinal decontamination, and supportive therapies directed at the multi-organ failure remain the standard of care.
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Affiliation(s)
- Nancy L. Fagan
- Department of Pharmacy Practice, Creighton University, Omaha, Nebraska
| | - Robert E. Wear
- Department of Pulmonary/Critical Care Medicine, Creighton University
| | - Mark A. Malesker
- Departments of Pharmacy Practice and Pulmonary/Critical Care Medicine, Creighton University
| | - Lee E. Morrow
- Department of Pulmonary/Critical Care Medicine, Creighton University
| | - Dan Schuller
- Department of Pulmonary/Critical Care Medicine, Creighton University
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Eleftheriou G, Bacis G, Fiocchi R, Sebastiano R. Colchicine-induced toxicity in a heart transplant patient with chronic renal failure. Clin Toxicol (Phila) 2008; 46:827-30. [DOI: 10.1080/15563650701779703] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kocak Z, Akay H, Gucenmez S, Tufan A, Donderici O. Colchicine intoxication and infection risk: a case report. J Clin Pharm Ther 2008; 33:451-2. [DOI: 10.1111/j.1365-2710.2008.00927.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Colchicine is a commonly used drug for the treatment of gout and other indications. Toxicity from intentional oral overdoses of colchicine has been reported. Two cases are reported here in which colchicine was given by intravenous injection, and patients presented with multiorgan toxicity. The authors tested plasma and urine colchicine levels in these patients and found them significantly elevated. Testing of the vial from which the colchicine injections were given showed that the vial was mislabeled and contained 10-fold greater concentration of drug than the labeling indicated. These patients thus received a bolus dose of 20 mg of intravenous colchicine rather than the intended 2-mg dose. An intravenous dose of this magnitude has not previously been reported.
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Affiliation(s)
- Jonathan S Sussman
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bonnel RA, Villalba ML, Karwoski CB, Beitz J. Deaths associated with inappropriate intravenous colchicine administration. J Emerg Med 2002; 22:385-7. [PMID: 12113850 DOI: 10.1016/s0736-4679(02)00430-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intravenous (IV) colchicine is occasionally prescribed for the treatment of acute gouty arthritis. The Food and Drug Administration (FDA) recently received a report of death in a patient that was associated with inappropriate IV dosing of colchicine. This report prompted further investigation of other deaths associated with IV colchicine use in the FDA Adverse Event Reporting System (AERS) and the medical literature. A total of 20 deaths were identified. Eight patients were females, 11 were males, and the gender was unknown in 1. In all cases, the recommended maximum cumulative dose of 2 to 4 mg during a course of therapy was exceeded. Dose reductions are recommended in patients with renal or hepatic disease and in the elderly. All reported adverse events were associated with colchicine toxicity, including thrombocytopenia, leukopenia, pancytopenia, agranulocytosis, aplastic anemia, acute renal failure, and disseminated intravascular coagulopathy. Death occurred within 1 to 40 days after drug administration. Therapeutic guidelines exist for use of IV colchicine and these guidelines should be followed to prevent serious toxicities and death.
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Affiliation(s)
- Renan A Bonnel
- Office of Drug Safety, Center for Drug Evaluation and Research, US Food and Drug Administration, Rockville, Maryland 20857, USA
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Dixon AJ, Wall GC. Probable colchicine-induced neutropenia not related to intentional overdose. Ann Pharmacother 2001; 35:192-5. [PMID: 11215839 DOI: 10.1345/aph.10184] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To report a case of neutropenia caused by colchicine not associated with intentional overdose or with preceding severe gastrointestinal symptoms. CASE SUMMARY A 68-year-old white man was admitted to the hospital with intractable pain from an acute attack of gout. The patient was treated with standard doses of oral colchicine for several days. He experienced mild loose stools, but no severe diarrhea or nausea during treatment. The patient then developed severe neutropenia, with an absolute neutrophil count of 240 cells/mm3. His white blood cell count returned to normal after discontinuing colchicine and administering filgrastim. DISCUSSION Although colchicine is commonly associated with neutropenia in cases of intentional or accidental overdose, the patient developed this adverse effect after being treated with doses commonly used for the acute treatment of gout. In addition, this patient had taken low-dose colchicine for many years without experiencing hematologic adverse effects. CONCLUSIONS Colchicine is often an attractive alternative to nonsteroidal antiinflammatory agents for the treatment of gout, especially in patients at risk for renal impairment or gastropathy. Our case illustrates that colchicine treatment can cause hematologic adverse effects; the clinician should monitor cell counts in patients receiving this agent, especially at the higher doses used for acute treatment of gout.
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Affiliation(s)
- A J Dixon
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311-4505, USA
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Harris R, Marx G, Gillett M, Kark A, Arunanthy S. Colchicine-induced bone marrow suppression: treatment with granulocyte colony-stimulating factor. J Emerg Med 2000; 18:435-40. [PMID: 10802421 DOI: 10.1016/s0736-4679(00)00160-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bone marrow aplasia is a frequent complication of colchicine poisoning. This typically occurs on day 3 to 5 postexposure, and the blood cell counts remain depressed for a week or more. Unfortunately, because patients suffering from colchicine toxicity develop multiple organ complications and sepsis, the morbidity and mortality associated with bone marrow depression is high. In this article, we present three cases of colchicine toxicity in which granulocyte colony-stimulating factor (G-CSF) was used to treat bone marrow depression. In all three cases, there was a dramatic increase in the white cell count and, to a lesser extent, the platelet count. In view of the critical nature of the bone marrow depression and multi-organ toxicity induced by colchicine, we believe that consideration of the use of G-CSF to shorten the duration of neutropenia is warranted.
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Affiliation(s)
- R Harris
- Department of Emergency Medicine, Royal North Shore Hospital, St. Leonards, Sydney, Australia
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Abstract
Colchicine poisoning is an uncommon, but potentially life-threatening, toxicologic emergency. A case is reported of a 21-year-old woman who presented to the emergency department approximately 1 hour after ingesting 30 mg of colchicine in a suicide attempt. Her clinical course included gastrointestinal distress, metabolic acidosis, pancytopenia, hypotension, adult respiratory distress syndrome, rhabdomyolysis, and hypocalcemia. Despite aggressive medical management, the patient suffered a cardiac arrest and died 8 days after the ingestion. The clinical features of colchicine poisoning are highlighted and current therapeutic options are discussed.
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Affiliation(s)
- S T Milne
- Department of Emergency Medicine, University of Cincinnati, OH 45267-0769, USA
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Yim JM, Matuszewski KA, Vermeulen LC, Ratko TA, Burnett DA, Vlasses PH. Surveillance of colony-stimulating factor use in US academic health centers. Ann Pharmacother 1995; 29:475-81. [PMID: 7544655 DOI: 10.1177/106002809502900504] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To characterize and evaluate hematopoietic colony-stimulating factor (CSF) use, including cost implications, in US academic health centers. DESIGN An observational study of patients who received granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) from September 1 to October 15, 1993. SETTING Thirty academic health centers in the US. PARTICIPANTS Five hundred sixty-five patients were evaluated. MAIN OUTCOME MEASURES The appropriateness of CSF use was assessed, based on consensus-derived indication guidelines and the Food and Drug Administration-approved product labeling. Indication, type of CSF, and dosage were considered in determining the appropriateness of CSF therapy. RESULTS Based on indication evaluation criteria, 71% of CSF use was appropriate, 7% was inappropriate, and 22% was unproven, although the majority of unproven use was deemed promising by the expert panel. Based on dosage evaluation criteria, 51% of CSF use was appropriate, 27% was inappropriate, and 22% was for promising and other unproven indications. More than 90% of the patients studied received G-CSF. Approximately 3.4% of patients who received G-CSF had an adverse event, compared with 22% of those who received GM-CSF. Approximately $791,000 was spent on CSF therapy in the 565 patients: $401,000 (51%) on appropriate indications and doses, $160,000 (20%) on inappropriate doses for appropriate indications, $124,000 (16%) on promising indications, and $106,000 (13%) on unproven or inappropriate indications. CONCLUSIONS Substantial costs are incurred currently for CSF therapy without adequate literature support. Further studies are warranted to justify promising but unproven uses of CSFs, as well as to clarify proper dosing, monitoring, and relative safety of CSFs.
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Affiliation(s)
- J M Yim
- Clinical Practice Advancement Center, University Hospital Consortium, Oak Brook, IL 60521, USA
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Folpini A, Furfori P. Colchicine toxicity--clinical features and treatment. Massive overdose case report. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1995; 33:71-7. [PMID: 7530779 DOI: 10.3109/15563659509020219] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This is a report of colchicine poisoning in a 24-year-old woman. She developed multiple organ failure and bone marrow suppression after the suicidal ingestion of 50 (1 mg) colchicine tablets. The pancytopenia responded to granulocyte colony-stimulating factor 300 micrograms on days 4, 5, 6, and 8. Although anticolchicine monoclonal antibody administration is the only specific therapy described, intensive supportive care including granulocyte colony-stimulating factor administration can facilitate recovery from severe colchicine intoxication.
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Affiliation(s)
- A Folpini
- Department of Anaesthesia, Intensive Care and Pain Therapy, Ospedale Regionale, Massa, Italy
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Geibig CB, Marks LW. Treatment of clozapine- and molindone-induced agranulocytosis with granulocyte colony-stimulating factor. Ann Pharmacother 1993; 27:1190-4. [PMID: 7504534 DOI: 10.1177/106002809302701006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To report a case of clozapine- and molindone-induced agranulocytosis and to discuss treatment using filgrastim, a granulocyte colony-stimulating factor. CASE SUMMARY A 64-year-old woman who had been on long-term clozapine therapy for schizophrenia was hospitalized with presumed drug-induced agranulocytosis. She had also been on short-term molindone therapy. A bone marrow biopsy and the initial white blood cell (WBC) count were consistent with drug-induced agranulocytosis. Following seven days of treatment with subcutaneous filgrastim 300 micrograms/d, her absolute neutrophil count was above 500 x 10(6)/L. DISCUSSION Reports in the literature discussing antipsychotic drug-induced agranulocytosis are reviewed. A relationship between treatment with filgrastim and WBC response is postulated. CONCLUSIONS Filgrastim may be useful in ameliorating the effects of clozapine- and molindone-induced agranulocytosis.
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Affiliation(s)
- C B Geibig
- Department of Pharmaceutical Services, Saint Mary's Health Services, Grand Rapids, MI 49503
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Gales BJ, Gales MA. Granulocyte-colony stimulating factor for sulfasalazine-induced agranulocytosis. Ann Pharmacother 1993; 27:1052-4. [PMID: 7693069 DOI: 10.1177/106002809302700907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To report a case of sulfasalazine-induced agranulocytosis that was successfully treated with granulocyte-colony stimulating factor (G-CSF). CASE SUMMARY An 82-year-old woman developed agranulocytosis within two months of initiating sulfasalazine therapy. She was hospitalized, empiric antibiotic and antifungal agents were prescribed, and sulfasalazine therapy was stopped. The patient received G-CSF 600 micrograms/d subcutaneously for six consecutive days, starting on hospital day 5. Agranulocytosis resolved on day 5 and leukopenia on day 6 of G-CSF therapy. No adverse reactions were attributed to administration of this agent and the patient was discharged on hospital day 13. DISCUSSION Numerous agents, including sulfasalazine, have been associated with agranulocytosis. Agranulocytic patients frequently experience life-threatening bacterial and fungal infections. Administration of colony stimulating factors may reduce the duration of agranulocytosis and incidence of life-threatening infections. CONCLUSIONS G-CSF administration appears to have decreased the duration of this elderly patient's agranulocytosis and hospitalization.
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Affiliation(s)
- B J Gales
- Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Weatherford
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