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Mirtazapine-induced neutropenic sepsis in an older person: a case report
Alice Maidwell-Smith1,2, Charlotte Kirk3
1University Hospitals Sussex NHS Foundation Trust, Worthing Hospital, Lyndhurst Rd, Worthing, West Sussex, BN11 2DH, UK. alice.maidwell-smith@nhs.net.
Background:
Mirtazapine is a frequently prescribed psychotropic drug for depression in older age. It is considered safe and has a side-effect profile uniquely favorable to an older person affected by reduced appetite, difficulty maintaining body weight, or insomnia. However, it is largely unknown that mirtazapine can cause a dangerous decline in neutrophil count.
Case Presentation:
We present a case of mirtazapine-induced severe neutropenia in a 91-year-old white British woman requiring drug withdrawal and granulocyte-colony stimulating factor administration.
Conclusion:
This case is of significance because mirtazapine is regarded as a safe, and often preferable, antidepressant in older age. However, this case demonstrates a rare, life-threatening side effect of mirtazapine and calls for greater pharmacovigilance when prescribing it. There is no previous report of mirtazapine-induced neutropenia requiring drug withdrawal and granulocyte-colony stimulating factor administration in an older person.
Insights
Mirtazapine, an antidepressant often prescribed for seniors, can cause severe neutropenia, a dangerous drop in white blood cells. This rare side effect necessitates careful monitoring and prompt medical intervention.
Area of Science:
- Geriatric Pharmacology
- Psychiatry
- Hematology
Background:
- Mirtazapine is a common psychotropic medication for depression in elderly patients.
- It is favored for its favorable side-effect profile in older adults, addressing appetite, weight, and insomnia.
- A potentially dangerous decline in neutrophil count is an underrecognized side effect.
Observation:
- A case report details severe neutropenia in a 91-year-old woman after mirtazapine use.
- The patient required mirtazapine withdrawal and granulocyte-colony stimulating factor (G-CSF) treatment.
Findings:
- Mirtazapine can induce severe neutropenia, a rare but life-threatening adverse drug reaction.
- This case highlights the first reported instance of mirtazapine-induced neutropenia in an elderly individual requiring G-CSF.
Implications:
- Greater pharmacovigilance is crucial when prescribing mirtazapine to older adults.
- This case challenges the perception of mirtazapine as universally safe in geriatric populations.
- Awareness of this rare side effect is vital for clinicians managing elderly patients with depression.
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