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Fatal agranulocytosis associated with psychotropic medication use
- Source :
- American Journal of Health-System Pharmacy. 69:863-867
- Publication Year :
- 2012
- Publisher :
- Oxford University Press (OUP), 2012.
-
Abstract
- Purpose A patient’s death due to severe hematologic adverse effects of the concomitant use of four psychotropic medications is reported. Summary A 40-year-old Caucasian woman with a 9-year history of depression and anxiety (managed with alprazolam) was admitted to a psychiatric hospital for the treatment of acute psychotic symptoms. After nine days, the patient was discharged home on a regimen of lamotrigine, mirtazapine, quetiapine, and venlafaxine. Five weeks later, the development of severe ocular cellulitis, severe oral thrush, and febrile neutropenia necessitated the woman’s urgent rehospitalization; on admission, her white blood cell count was 600 cells/mm 3 , her absolute neutrophil count was 18 cells/mm 3 , and microbial pathogens were isolated in peripheral blood and tracheal aspirate cultures. Despite treatment with antibiotics and filgrastim, the patient developed multiorgan dysfunction and died five days later from septic shock. The woman’s concomitant use of multiple psychotropics and the late recognition of drug-induced agranulocytosis likely contributed to her severe symptoms and ultimate death. The application of the Naranjo scale to this case yielded a score of 6, indicating a probable adverse drug reaction. Although hematologic adverse effects have been reported with the use of each of the four drugs implicated in the woman’s death, this is thought to be the first report of fatal agranulocytosis associated with any of the drugs. Conclusion A 40-year old woman with a history of acute psychotic symptoms developed agranulocytosis and neutropenia after starting therapy that included lamotrigine, mirtazapine, quetiapine, and venlafaxine.
- Subjects :
- Adult
Dibenzothiazepines
medicine.medical_specialty
Neutropenia
Filgrastim
Multiple Organ Failure
Mirtazapine
Venlafaxine
Mianserin
Lamotrigine
Quetiapine Fumarate
Fatal Outcome
Antimanic Agents
Internal medicine
Granulocyte Colony-Stimulating Factor
medicine
Humans
Adverse effect
Pharmacology
Depressive Disorder, Major
Psychotropic Drugs
Triazines
business.industry
Health Policy
Venlafaxine Hydrochloride
Orbital Cellulitis
Cyclohexanols
medicine.disease
Shock, Septic
Recombinant Proteins
Blood Cell Count
Psychotic Disorders
Anesthesia
Absolute neutrophil count
Antidepressive Agents, Second-Generation
Quetiapine
Female
business
Adverse drug reaction
Febrile neutropenia
Agranulocytosis
Antipsychotic Agents
medicine.drug
Subjects
Details
- ISSN :
- 15352900 and 10792082
- Volume :
- 69
- Database :
- OpenAIRE
- Journal :
- American Journal of Health-System Pharmacy
- Accession number :
- edsair.doi.dedup.....aea49e0743b722609ef6d7f6e43026d7