Drugs associated with neutropenia or agranulocytosis
| Class . | Drug . | Frequency reported . | Nature of reaction . |
|---|---|---|---|
| Antibiotics | Semisynthetic penicillins (amoxicillin, ampicillin*) | Int | Both |
| Cephalosporins | Int | 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 | Int | Agranulocytosis | |
| Antiinflammatory agents | Ibuprofen* | Low | Agranulocytosis |
| Diclofenac* | Int | Agranulocytosis | |
| Sulfasalazine* | High | Agranulocytosis | |
| Gold salts | Agranulocytosis | ||
| Antithyroid drugs | Methimazole* | High | Agranulocytosis |
| Propylthiouracil | Int | Agranulocytosis | |
| Psychotropic agents | Clozapine* | High | Agranulocytosis |
| Phenothiazines (chlorpromazine) | Int | Agranulocytosis | |
| Tricyclic agents (amitriptyline*) | Low | Agranulocytosis | |
| Antiepileptics | Carbamazepine* | Low | Neutropenia |
| Phenytoin* | Int | Agranulocytosis | |
| Valproate | Low | Neutropenia | |
| Ethosuximide | Low | Neutropenia | |
| Cardiovascular drugs | Antiarrhythmic agents (procainamide,* flecainide*) | High | Agranulocytosis |
| ACE inhibitors | Int | Agranulocytosis | |
| Propranolol | Low | Agranulocytosis | |
| Digoxin* | Int | Agranulocytosis | |
| Ticlopidine | High | Agranulocytosis | |
| Diuretics | Thiazides* | Low | Neutropenia |
| Furosemide | Low | Neutropenia | |
| Spironolactone* | Low | Agranulocytosis | |
| Acetazolamide | Low | Neutropenia | |
| Other | Deferiprone* | Int | Agranulocytosis |
| Levamisole | Int | Agranulocytosis | |
| Rituximab | Int | Agranulocytosis |
| Class . | Drug . | Frequency reported . | Nature of reaction . |
|---|---|---|---|
| Antibiotics | Semisynthetic penicillins (amoxicillin, ampicillin*) | Int | Both |
| Cephalosporins | Int | 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 | Int | Agranulocytosis | |
| Antiinflammatory agents | Ibuprofen* | Low | Agranulocytosis |
| Diclofenac* | Int | Agranulocytosis | |
| Sulfasalazine* | High | Agranulocytosis | |
| Gold salts | Agranulocytosis | ||
| Antithyroid drugs | Methimazole* | High | Agranulocytosis |
| Propylthiouracil | Int | Agranulocytosis | |
| Psychotropic agents | Clozapine* | High | Agranulocytosis |
| Phenothiazines (chlorpromazine) | Int | Agranulocytosis | |
| Tricyclic agents (amitriptyline*) | Low | Agranulocytosis | |
| Antiepileptics | Carbamazepine* | Low | Neutropenia |
| Phenytoin* | Int | Agranulocytosis | |
| Valproate | Low | Neutropenia | |
| Ethosuximide | Low | Neutropenia | |
| Cardiovascular drugs | Antiarrhythmic agents (procainamide,* flecainide*) | High | Agranulocytosis |
| ACE inhibitors | Int | Agranulocytosis | |
| Propranolol | Low | Agranulocytosis | |
| Digoxin* | Int | Agranulocytosis | |
| Ticlopidine | High | Agranulocytosis | |
| Diuretics | Thiazides* | Low | Neutropenia |
| Furosemide | Low | Neutropenia | |
| Spironolactone* | Low | Agranulocytosis | |
| Acetazolamide | Low | Neutropenia | |
| Other | Deferiprone* | Int | Agranulocytosis |
| Levamisole | Int | Agranulocytosis | |
| Rituximab | Int | Agranulocytosis |
Excludes drugs for which neutropenia is an expected side effect (eg, chemotherapy). Int, intermediate.
“Frequency reported” refers to the number of case reports in recent systematic reviews for each drug, but is not always normalized to the frequency with which each drug is prescribed and thus may not accurately represent the true risk associated with these drugs.37
“Nature of reaction” means that all of the drugs in this table have been reported to be associated with agranulocytosis, but some more frequently cause dose-related neutropenia in clinical practice.
Denotes drug for which specific attributable risk has been reported in either case-controlled studies or studies normalized to the prescription rate.