Treatment of gout in a renal transplant patient leading to severe thrombocytopenia

Summary What is known and objective Allopurinol (AP) inhibits the xanthine oxidase, which may indirectly lead to myelotoxicity when used in combination with azathioprine (AZA). Case summary A 79‐year‐old female developed symptomatic thrombocytopenia after combination therapy with AZA (75 mg/day) and...

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Bibliographic Details
Published in:Journal of clinical pharmacy and therapeutics 2014-10, Vol.39 (5), p.571-572
Main Authors: Weiler, S., Aellig, N., Fauchère, I., Jetter, A., Corti, N.
Format: Article
Language:English
Subjects:
6‐thioguanine‐nucleotides
adverse reaction
Aged
allopurinol
Allopurinol - administration & dosage
Allopurinol - adverse effects
azathioprine
Azathioprine - administration & dosage
Azathioprine - adverse effects
Biological and medical sciences
Diagnosis, Differential
Diseases of the osteoarticular system
drug interaction
Female
Gout - drug therapy
Gout Suppressants - administration & dosage
Gout Suppressants - adverse effects
Humans
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - adverse effects
Inflammatory joint diseases
Kidney Transplantation
Medical sciences
Metabolic diseases
Miscellaneous. Osteoarticular involvement in other diseases
Other metabolic disorders
pharmacodynamics
Pharmacology. Drug treatments
Purines and pyrimidines (gout, hyperuricemia...)
Severity of Illness Index
Thrombocytopenia - chemically induced
Thrombocytopenia - diagnosis
Thrombocytopenia - pathology
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Summary:Summary What is known and objective Allopurinol (AP) inhibits the xanthine oxidase, which may indirectly lead to myelotoxicity when used in combination with azathioprine (AZA). Case summary A 79‐year‐old female developed symptomatic thrombocytopenia after combination therapy with AZA (75 mg/day) and AP (100 mg/day) – after AP had been stopped. Concentrations of the myelotoxic 6‐thioguanine‐nucleotides metabolite of AZA were increased. Thrombocyte counts normalized within 8 days of discontinuation of AZA. What is new and conclusion The effect of a drug interaction in a patient with decreased elimination capacity may take several weeks to become apparent and may in fact do so even after the drug has been stopped. Concurrent AZA and AP therapy demands cautious use. A 79‐year old female developed symptomatic thrombocytopenia after combination therapy with azathioprine (75 mg/day) and allopurinol (100 mg/day) – after allopurinol had been stopped. Concentrations of the myelotoxic 6‐TGN of azathioprine were increased. Thrombocyte counts normalized within 8 days of discontinuation of azathioprine.
ISSN:0269-4727
1365-2710
DOI:10.1111/jcpt.12190