Antipsychotic-induced thrombocytopenia is generally rare, but seems to occur more frequently with quetiapine. Accordingly, the relative risk of thrombocytopenia can be described as very rare with loxapine and clozapine (< 0.01%), uncommon with risperidone (≥ 0.1%, < 1%), but very common with quetiapine (≥ 10%). However, very few cases are reported in the literature,11. Huynh M, Chee K, Lau DH. Thrombotic thrombocytopenic purpura associated with quetiapine. Ann Pharmacother. 2005;39:1346-8. 22. Shankar BR. Quetiapine-induced leucopenia and thrombocytopenia. Psychosomatics. 2007;48:530-1. 33. Perrella C, Carrus D, Costa E, Schifano F. Quetiapine for the treatment of borderline personality disorder; an open-label study. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:158-63. 44. Handoo I, Perales M, Klaus N, Khan AY. Thrombocytopenia secondary to the use of quetiapine. J Child Adolesc Psychopharmacol. 2010;20:453-5. with one published case of idiopathic thrombocytopenic purpura,11. Huynh M, Chee K, Lau DH. Thrombotic thrombocytopenic purpura associated with quetiapine. Ann Pharmacother. 2005;39:1346-8. and it remains unclear whether rechallenge may be considered.
Patient no. 1 was a 78-year-old male hospitalized for depressive syndrome and treated with mirtazapine 45 mg/day, valpromide 1,000 mg/day, and oxazepam 30 mg/day. Quetiapine was added at 50 mg/day, while mirtazapine was reduced to 30 mg/day. Laboratory tests carried out the following day and 5 days after the start of treatment with quetiapine revealed platelet counts of 100,000/mm3 and 56,000/mm3 respectively. Two further measurements were obtained, 8 days and 28 days after discontinuing treatment with quetiapine, showing higher platelet levels of 85,000/mm3 and 120,000/mm3 respectively.
Patient no. 2 was a 72-year-old female hospitalized for personality disorders with hallucinations and treated with aripiprazole 15 mg/day, clonazepam 0.6 mg/day, valproic acid 1,500 mg/day, furosemide 40 mg/day, lisinopril 20 mg/day, nebivolol 5 mg/day, and amlodipine 10 mg/day. During her hospitalization, aripiprazole was stopped and quetiapine 50 mg/day was introduced. Tests performed 3 months after initiating treatment with quetiapine were notable for a platelet count of 107,000/mm3. Six days later, a second test was carried out, and the platelet count was down to 95,000/mm3. Treatment with quetiapine was suspended for 3 days, following which the platelet count went back up to 120,000/mm3. The psychiatrist reintroduced quetiapine and scheduled a control platelet test 5 days later, which showed a decrease to 84,000/mm3. In view of this positive rechallenge, quetiapine was discontinued definitively. Fifteen days after quetiapine discontinuation, the platelet count was 123,000/mm3.
In both situations, no other clinical or iatrogenic parameter seemed to account for the onset of thrombocytopenia. To our knowledge, the second patient described herein is the first case of quetiapine-induced thrombocytopenia with positive rechallenge to be in the literature.
References
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1Huynh M, Chee K, Lau DH. Thrombotic thrombocytopenic purpura associated with quetiapine. Ann Pharmacother. 2005;39:1346-8.
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2Shankar BR. Quetiapine-induced leucopenia and thrombocytopenia. Psychosomatics. 2007;48:530-1.
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3Perrella C, Carrus D, Costa E, Schifano F. Quetiapine for the treatment of borderline personality disorder; an open-label study. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:158-63.
-
4Handoo I, Perales M, Klaus N, Khan AY. Thrombocytopenia secondary to the use of quetiapine. J Child Adolesc Psychopharmacol. 2010;20:453-5.
Publication Dates
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Publication in this collection
Dec 2015
History
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Received
24 June 2015 -
Accepted
11 July 2015