Drug | Mechanism(s) |
Abciximab | DITP |
Aceclofenac | DITP |
Acetaminophen | DITP; antibodies react with a drug metabolite, not the unmodified drug |
Alemtuzumab | ITP* |
Amiodarone | DITP |
Aspirin | DITP |
Atezolizumab | DITP |
Aztreonam | DITP |
Beta-lactam antibiotics (penicillins, cephalosporins, flucloxacillin) | DITP |
Bisoprolol | DITP |
Carbamazepine | DITP |
Ceftriaxone | DITP |
Cetirizine | DITP |
COVID-19 vaccines | ITP, VITT (only adenoviral-vectored vaccines are known to cause VITT) |
Daptomycin | Bone marrow suppression (dose-dependent) and DITP |
Dexamethasone | DITP |
Diazoxide | DITP |
Diclofenac | DITP |
Diltiazem | DITP |
Durvalumab | DITP |
Eptifibatide | DITP |
Ethambutol | DITP |
Ethosuximide | DITP |
Exenatide | DITP |
Felbamate | DITP |
Fluorouracil | DITP |
Furosemide | DITP |
Gold compounds | DITP that may persist after the drug is stopped |
Haloperidol | DITP |
Heparin | Drug-dependent antibodies that also activate platelets and are associated with thrombosis |
Ibuprofen | DITP; in some patients, antibodies react with the unmodified drug; in others, antibodies only react with a drug metabolite |
Influenza vaccine (trivalent, inactivated) | DITP |
Intravenous immune globulin (IVIG) | DITP |
Ipilimumab | ITP¶ |
Irinotecan | DITP |
Leucovorin | DITP |
Levofloxacin | DITP |
Linezolid | Bone marrow suppression (dose-dependent) |
MMR vaccine | ITP |
Mirtazapine | DITP |
Naproxen | DITP; antibodies react with a drug metabolite, not the unmodified drug |
Natalizumab | ITP |
Nivolumab | ITP¶ |
Ondansetron | DITP |
Oseltamivir | DITP |
Oxaliplatin | DITP |
Palonosetron | DITP |
Pembrolizumab | ITP¶ |
Penicillin | DITP |
Phenytoin | DITP |
Piperacillin (component of piperacillin-tazobactam) | DITP |
Pyrazinamide | DITP |
Quetiapine | DITP |
Quinidine | DITP |
QuinineΔ | DITP |
Rifampin | DITP |
Simvastatin | DITP |
Sulfonamides | DITP |
Suramin | DITP |
Tacrolimus | DITP |
Teicoplanin | DITP |
Tirofiban | DITP |
Trastuzumab | DITP |
Trimethoprim-sulfamethoxazole | DITP; antibodies to both components have been identified |
Valproic acid | Bone marrow suppression (dose-dependent) |
Vancomycin◊ | DITP |
Volanesorsen | Unknown |
This table lists drugs with evidence for a causal association with isolated thrombocytopenia; certain foods and beverages (eg, quinine-containing beverages, certain herbal teas, walnuts) can also cause thrombocytopenia. The drugs listed in this table come from clinical data in published case reports, identification of drug-dependent, platelet-reactive antibodies, or both; it also lists their mechanisms.
Criteria for evaluating reports of a drug-induced etiology include:Drugs in bold have been most commonly implicated in a causal relationship. Drug-dependent antibodies have been shown for all agents associated with DITP with the exceptions of aspirin, ethosuximide, exenatide, filgrastim, and linezolid.[1,2]
Refer to UpToDate for additional information on drug-induced thrombocytopenia.COVID-19: coronavirus disease 2019; DITP: drug-induced immune thrombocytopenia, caused by drug-dependent antibodies; ITP: immune thrombocytopenia, caused by an autoimmune mechanism that no longer requires the presence of the drug; MMR: measles, mumps, and rubella; VITT: vaccine-induced immune thrombotic thrombocytopenia.
* ITP is a rare adverse reaction to alemtuzumab. Thrombocytopenia typically presents months after alemtuzumab exposure and responds well to standard ITP therapies.
¶ Thrombocytopenia may occur when the patient is not actively on the drug; it often responds to standard ITP therapies.
Δ Quinine can also cause a thrombotic microangiopathy and/or other cytopenias.
◊ In addition to parenteral formulations, vancomycin may be present in orthopedic cement used for joint replacement.Do you want to add Medilib to your home screen?