From the Guidelines
Medications that can cause thrombocythemia include epinephrine, vincristine, all-trans retinoic acid, and certain growth factors like thrombopoietin receptor agonists (eltrombopag and romiplostim), as well as corticosteroids, certain antibiotics, and some chemotherapy agents during recovery phases. These medications can stimulate platelet production in the bone marrow or redistribute platelets from storage sites into circulation, leading to an abnormally high platelet count in the blood. Some key medications to note are:
- Epinephrine
- Vincristine
- All-trans retinoic acid
- Thrombopoietin receptor agonists (eltrombopag and romiplostim)
- Corticosteroids (prednisone, dexamethasone)
- Certain antibiotics (vancomycin)
- Some chemotherapy agents during recovery phases
- Hormone therapies like estrogen and testosterone It's essential to distinguish medication-induced thrombocythemia from primary thrombocythemia, which is a myeloproliferative disorder. If you develop an elevated platelet count while taking any medication, consult with your healthcare provider before making any changes to your treatment regimen, as they can determine whether the medication is the cause and if any intervention is needed 1. In general, drug-induced thrombocythemia is usually temporary and resolves when the medication is discontinued. However, it's crucial to monitor platelet counts and adjust treatment as necessary to prevent complications. The most recent and highest quality study on this topic is from 2018, which highlights the importance of careful medication management in patients at risk of thrombocythemia 1.
From the Research
Medications that Cause Thrombocythemia
There are several medications that can cause thrombocythemia, including:
- Vinca alkaloids, which have been shown to induce thrombocytosis through their thrombocyte-stimulating properties 2
- Miconazole, an antifungal medication that has been implicated in causing thrombocytosis 2
- Iron, which can cause a transient thrombocytosis 2
- Adrenalin, which can cause platelet elevations due to demargination of platelets in the pulmonary vasculature 2
- Beta-lactam antibiotics, although the data is difficult to interpret due to the possibility of an acute-phase reaction in an infected patient being the cause of the thrombocytosis 2
Mechanisms of Thrombocythemia
The mechanisms by which these medications cause thrombocythemia are not fully understood, but may involve:
- Stimulation of thrombocyte production, as seen with vinca alkaloids 2
- Demargination of platelets in the pulmonary vasculature, as seen with adrenalin 2
- Induction of an acute-phase reaction, as seen with beta-lactam antibiotics 2
Treatment of Thrombocythemia
Treatment of thrombocythemia typically involves reducing the platelet count to prevent thrombotic complications, and may include medications such as:
- Hydroxyurea, which can be used to reduce platelet counts in patients with essential thrombocythemia 3
- Anagrelide, which can be used to reduce platelet counts in patients with essential thrombocythemia 3, 4
- Interferon-alpha, which can be used to reduce platelet counts in patients with essential thrombocythemia 3
- Aspirin, which can be used to prevent thrombotic complications in patients with thrombocythemia 3, 5