End organ damage in levamisole adulterated cocaine: More than just purpura and agranulocytosis
Relationship between the number of febrile days and the number of days of agranulocytosis
In order to determine a causative relationship between agranulocytosis
or neutropenia and a medication, several conditions must be fulfilled (4): (i) the drug must have been prescribed for 10 days prior to the first symptoms of a haematological reaction (challenge); (ii) the patient recovers on discontinuation of therapy (dechallenge); (iii) there is only 1 possible cause of the haematological reaction; (iv) the patient has not received cytostatic drugs, immunosuppressive agents, or radiotherapy in the 6 weeks prior to onset of the blood disorder; and (v) no systemic disease exists that could have given rise to the neutropenia.
Incidence and risk factors for agranulocytosis
in Latin American countries--the Latin Study: a multicenter study.
The clozapine-associated risk of agranulocytosis
is well established; however clinicians should also be cautious of the risk for other blood dyscrasias, such as leukocytosis.
Potential life-threatening adverse effects of methimazole include leukopenia, thrombocytopenia, and agranulocytosis
(Wilson et al.
Pagoni, "Clozapine-induced late Agranulocytosis
and severe Neutropenia complicated with Streptococcus pneumonia, venous thromboembolism, and allergic vasculitis in treatment-resistant female psychosis," Case Reports in Medicine, vol.
Long-term patient monitoring for clozapine-induced agranulocytosis
and neutropenia in Korea: when is it safe to discontinue CPMS?
1,2) The Food and Drug Administration banned the use of levamisole in the United States in 2000 because of adverse side effects including agranulocytosis
The main issue with this adulteration is due to the immunomodulating and immunostimulating effects of levamisole, associating it significantly to agranulocytosis
and vasculitis, with skin lesions that are self-limiting when the substance use is stopped (2,3).
Carbidopa may induce life-threatening events, including myocardial infarction, neuroleptic malignant syndrome, agranulocytosis
, hemolytic and nonhemolytic anemia, gastrointestinal bleeding, thrombocytopenia, hypokalemia, and 90 other syndromes.
Clozapine can cause agranulocytosis
and requires a white blood cell count and an absolute neutrophil count weekly for the first six months of treatment, every other week for the next six months of treatment and then once monthly for duration of treatment.
Influenza B pneumonia with Staphylococcus aureus superinfection associated with parvovirus B19 and concomitant agranulocytosis
1] A life-threatening adverse effect sometimes associated with clozapine use is agranulocytosis
Rare adverse reactions to antibiotics Vancomycin induced agranulocytosis