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Spironolactone-induced agranulocytosis
K T Jivraj1, T W Noseworthy, E G Friesen
1Department of Adult Intensive Care, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Drug Intelligence & Clinical Pharmacy
|December 1, 1987
Summary
Spironolactone can cause agranulocytosis, a dangerous drop in white blood cells. This case highlights the need for vigilance regarding this rare but serious adverse drug reaction.
Area of Science:
- Pharmacology
- Hematology
- Clinical Medicine
Background:
- Spironolactone is a potassium-sparing diuretic used to treat hypertension and heart failure.
- Adverse drug reactions, including hematological abnormalities, can occur with spironolactone use.
Observation:
- A 57-year-old man developed agranulocytosis (severe neutropenia) four days after starting spironolactone.
- Leukocyte counts dropped significantly, with a marked decrease in neutrophils.
Findings:
- Discontinuation of spironolactone led to recovery of leukocyte and neutrophil counts.
- Reintroduction of concomitant medications (domperidone, prochlorperazine) did not cause recurrence.
- Substitution with triamterene did not result in recurrent leukopenia.
Implications:
- This case underscores the potential for spironolactone to cause granulocytopenia.
- Increased clinical awareness is crucial for early detection and management of this rare adverse drug reaction.
- Careful monitoring of blood counts may be warranted in patients receiving spironolactone.