Psychosomatics 46:89-90, February 2005
© 2005 The Academy of Psychosomatic Medicine
Blood Dyscrasia With Quetiapine and Ziprasidone
Preetha Nair, M.D., and
Steven Lippmann, M.D., Louisville, Ky.
TO THE EDITOR: Pharmaceutically induced blood dyscrasias with bone marrow suppression from antipsychotic drugs are a subject of current concern. Both the first and second generations of such medicines have been implicated.1 Quetiapine can cause hematological abnormalities.2 Although blood dyscrasias are noted in the ziprasidone package insert, there is only sparse literature available about this subject.3 This case report documents hematological abnormalities that developed twice with quetiapine administration, normalized when it was discontinued, and reoccurred in one cycle with ziprasidone.
Case Report
Ms. A, a 29-year-old African American woman with polypharmacy drug abuse, was hospitalized with psychotic symptoms and treated with oral quetiapine, 600 mg/day. Her blood count was normal at admission. The next day, after quetiapine administration, her blood count had dropped significantly. Quetiapine was discontinued, and a follow-up evaluation revealed hematological improvement. Oral quetiapine was restarted at 600 mg/day, and her blood count again decreased. Quetiapine was again discontinued. Since Ms. A remained psychotic, oral ziprasidone was prescribed at 40 mg/day and was later increased to 120 mg/day. An abnormal blood profile reoccurred, but it returned to Ms. A’s baseline level once antipsychotic drugs were discontinued.
Mild macrocytosis was discovered; Ms. A had no signs of infection. A hematology consultation revealed chronic macrocytic anemia and myelodysplastic syndrome. Both quetiapine and ziprasidone appeared to have independently precipitated a worsening blood dyscrasia. These drugs were discontinued, and Ms. A’s blood count improved. Her mental status normalized with gabapentin and trazodone; no antipsychotic drugs were prescribed.
Discussion
Verifying that a certain medicine has precipitated blood dyscrasia is best determined by the following: a previously normal blood profile becomes abnormal without a contributing medical cause during use of a specific drug, the hematological abnormality corrects itself when the offending agent is discontinued and reoccurs with a rechallenge, and a hemogram becomes normal again after drug discontinuation.4 This pattern was twice seen with quetiapine and then once during ziprasidone use in this patient.
Bone marrow suppressions are known to be associated with the use of first-generation antipsychotic drugs; recently, second generation agents, too, have become a concern in this regard. Physicians prescribing them should be aware of this adverse reaction. Screening with repeated hemograms is advised as a safety precaution. Blood profile monitoring is especially critical when such pharmaceutical use is associated with signs of infection, anemia, or related difficulties. Long-term clinical experience should clarify the frequency and dangers of this side effect.
REFERENCES
- Oyensami O, Kunkel EJS, Monti DA, Field HL: Hematologic side effects of psychotropics. Psychosomatics 1999; 40: 414–421
- Iraqi A: A case report of pancytopenia with quetiapine use. Am J Geriatric Psychiatry 2003; 11:694[CrossRef][Medline]
- Ziprasidone package insert. New York, Pfizer Inc, 2003
- Carey PJ: Drug-induced myelosuppression: diagnosis and management. Drug Saf 2003; 26:691–706[CrossRef][Medline]
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