Can Hydroxyurea be taken while being treated for an infection?

Hydroxyurea During Infection: Safety Considerations and Management

Hydroxyurea should generally be temporarily discontinued during active infections due to its myelosuppressive effects, which can worsen infection outcomes by compromising immune function. 1

Risks of Continuing Hydroxyurea During Infection

• Hydroxyurea causes bone marrow suppression affecting all cell lines, including white blood cells needed to fight infection 2, 1
• Myelosuppression is a primary concern, with monitoring of blood counts recommended weekly throughout therapy 1
• Patients should report signs and symptoms of infection immediately when taking hydroxyurea 1
• Hydroxyurea may increase the risk of severe infections when combined with other immunosuppressive treatments 1

Disease-Specific Considerations

Myeloproliferative Disorders

• For patients with polycythemia vera or essential thrombocythemia, infection during hydroxyurea treatment may exacerbate cytopenia, particularly if platelet counts fall below 100 x 10^9/L 2, 3
• Hydroxyurea-induced fever has been reported in patients with myeloproliferative disorders, which can complicate the assessment of infection 4

Sickle Cell Disease

• In sickle cell disease, hydroxyurea plays a critical role in reducing complications, but temporary dose adjustment may be needed during infection 3
• The benefits of continuing hydroxyurea in sickle cell disease patients with stable infections may outweigh risks in some cases, as it reduces vaso-occlusive crises 3

HIV Infection

• Patients with HIV infection should contact their physician for signs of infection while on hydroxyurea 1
• Hydroxyurea may increase the risk of pancreatitis, hepatic events, and peripheral neuropathy in HIV patients 3, 5

Management Recommendations

• Temporarily discontinue hydroxyurea at the first sign of infection until the infection resolves 1
• Monitor complete blood counts more frequently during and after infection 1
• Consider dose reduction rather than complete discontinuation for patients with chronic conditions requiring continuous hydroxyurea therapy, based on blood count monitoring 2
• Resume hydroxyurea at a potentially lower dose after resolution of infection, with close monitoring of blood counts 2, 1

Special Considerations

• Hydroxyurea can cause pulmonary toxicity that may mimic respiratory infection, including pneumonitis with fever, cough, and dyspnea 6
• Rechallenge with hydroxyurea after fever resolution can help distinguish between drug-induced fever and infection 4
• Patients should be advised to seek prompt medical attention for fever, cough, dyspnea, or other respiratory symptoms while taking hydroxyurea 1

Monitoring During and After Infection

• Weekly complete blood count monitoring is essential when restarting hydroxyurea after infection 1
• Assess for signs of bone marrow recovery before reinitiating therapy 1
• Monitor for potential drug interactions between hydroxyurea and antimicrobial agents 3

Hydroxyurea's myelosuppressive effects warrant caution during infection, and the decision to continue or discontinue should be made based on the severity of infection, underlying condition being treated, and current blood counts.