Zidovudine Induced Pancytopenia: A Case Study
Abstract
Zidovudine is the oldest anti-retroviral agent that is in clinical use. It’s common adverse effects are headaches (42-62.5%), nausea (46-61%), anorexia (11-20%), vomiting (6-25%), anemia (1.1-29%), granulocytopenia (1.8-37%) and neutropenia (3%).
This study is to increase awareness of Zidovudine induced pancytopenia. This is an observational type of case report of a 40 year old man with known complaints of HIV on anti-retroviral therapy since 8 years who came with complaints of easy fatigability since 1 year which was aggravated since 1 week, epigastric discomfort, constipation since 2 weeks, chest pain retrosternal in position which was radiating to both upper limbs, sweating, palpitations, decreased appetite since 1 week and cough with expectoration.
He was given tablet ZLN (Zidovudine 300 mg + Lamivudine 150 mg + Nevirapine 200 mg) twice daily regularly for the past 8 years. His last CD4 count was 300 cell/mm3. He had pallor. His laboratory results were: hemoglobin (6.6 g/dL), TLC (2400/μL), platelets (18,000/μL), neutrophil (36%) and MCV (107.4fL). He was diagnosed with pancytopenia (dimorphic anemia + leucopenia + thrombocytopenia) and neuropathic pain.
It was confirmed to be Zidovudine induced pancytopenia by objective analysis and Naranjo score suggesting “probable” interpretation. Pancytopenia improved after withholding Zidovudine along with Oxcarbazepine. Suggestion was made to change his anti-retroviral regimen once his counts improve. Tenofovir + Lamivudine (or Emtricitabine) + Efavirenz is the preferred first line combination therapy according to latest WHO guidelines (2013 and 2015). In case Zidovudine is used in first line combination therapy (2009 WHO guidelines), physicians should monitor for its toxicity.
A clinical pharmacist can help in such situations by creating awareness among prescribers regarding latest WHO and other recommended guidelines, checking whether the prescriptions follow these guidelines and also by monitoring patients for toxicities.
Keywords: Zidovudine, Drug induced pancytopenia, Adverse drug reaction
Keywords:
Zidovudine, Drug induced pancytopenia, Adverse drug reactionDOI
https://doi.org/10.22270/jddt.v11i5.4979References
Khalili H, Dashti‐Khavidaki S, Mohraz M, Etghani A, Almasi F. Antiretroviral induced adverse drug reactions in Iranian human immunodeficiency virus positive patients. Pharmaco- epidemiology and drug safety. 2009 Sep; 18(9):848-57. https://doi.org/10.1002/pds.1793
https://pdf.usaid.gov/pdf_docs/Pnacj572.pdf
http://sideeffects.embl.de/drugs/5726/
http://shodhganga.inflibnet.ac.in/bitstream/10603/13064/12/12_chapter2.pdf.pdf
Sharma A, Vora R, Modi M, Sharma A, Marfatia Y. Adverse effects of antiretroviral treatment. Indian Journal of Dermatology, Venereology, and Leprology. 2008 May 1; 74(3):234. https://doi.org/10.4103/0378-6323.41368
Modayil RR, Harugeri A, Parthasarathi G, Ramesh M, Prasad R, Naik V, Giriyapura V. Adverse drug reactions to antiretroviral therapy (ART): an experience of spontaneous reporting and intensive monitoring from ART centre in India. Pharmacoepidemiology and drug safety. 2010 Mar; 19(3):247-55. https://doi.org/10.1002/pds.1907
Mugisha JO, Donegan K, Fidler S, Ramjee G, Hodson A, Dunn DT, Porter K, Kaleebu P. Mean corpuscular volume as a marker for adherence to Zidovudine-containing therapy in HIV-infected adults. The open AIDS journal. 2012; 6:45. https://doi.org/10.2174/1874613601206010045
Sharma SK. Zidovudine-induced anaemia in HIV/AIDS. Indian Journal of Medical Research. 2010 Oct 1; 132(4):359-62.
https://accesspharmacy.mhmedical.com/content.aspx?sectionid=146079796&bookid=1861
Park K. Parks Textbook of Preventive in Social Medicine. Jabalpur: Banarsidas Bhanot Publishers; 2015; 357 - 359.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infections, June 2015; 98 - 100, Available at http://apps.who.int /medicinedocs/pdf/s4876e/s4876e.pdf.
Reddy, M. Y., Lokesh, A., Sivaranjani, V., Lakshmi, S. V. & Subbaiah, M. V. Zidovudine Induced Hematological Disorders and Hyperpigmentation. World Journal of Pharmacy and Pharmaceutical Sciences, 2017; 6:1285-1290
Published
Abstract Display: 866 
PDF Downloads: 1196 PDF Downloads: 125 How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
How to Cite
.