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Brazilian Journal of Psychiatry

Print version ISSN 1516-4446On-line version ISSN 1809-452X

Rev. Bras. Psiquiatr. vol.37 no.4 São Paulo Oct./Dec. 2015

https://doi.org/10.1590/1516-4446-2015-1766 

LETTERS TO THE EDITORS

Thrombocytopenia with quetiapine: two case reports, one with positive rechallenge

Alexandre Lalli1 

Bruno Michel2 

Sébastien Georget1 

Catherine Bouillot3 

Anne Mangin1 

Hervé Javelot4 

1Service Pharmacie, Centre Psychothérapique de Nancy - Laxou (CPN Laxou), Laxou, France

2Service Pharmacie, Centres Hospitaliers et Universitaires, Strasbourg, France

3Service de soins Archambault, CPN Laxou, Laxou, France

4Service Pharmacie, Etablissement Public de Santé Alsace Nord, Brumath, France


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,1 2 3 4 with one published case of idiopathic thrombocytopenic purpura,1 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

1. Huynh M, Chee K, Lau DH. Thrombotic thrombocytopenic purpura associated with quetiapine. Ann Pharmacother. 2005;39:1346-8. [ Links ]

2. Shankar BR. Quetiapine-induced leucopenia and thrombocytopenia. Psychosomatics. 2007;48:530-1. [ Links ]

3. 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. [ Links ]

4. Handoo I, Perales M, Klaus N, Khan AY. Thrombocytopenia secondary to the use of quetiapine. J Child Adolesc Psychopharmacol. 2010;20:453-5. [ Links ]

Received: June 24, 2015; Accepted: July 11, 2015

Disclosure The authors report no conflicts of interest.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.