Drugs reported to cause drug-induced thrombotic microangiopathy (DITMA)

Drug	Mechanism
Drug	Immune	Non-immune
Antibiotics
Rifampin^*
Sulfisoxazole	X
Trimethoprim-sulfamethoxazole	X
Antipsychotics
Quetiapine	X
Antiseizure medications
Valproic acid		X
Cancer therapies
Bevacizumab		X
Bortezomib		X
Carfilzomib		X
Dasatinib		X
Docetaxel		X
Gemcitabine	X	X
Imatinib		X
Ixazomib		X
Mitomycin		X
Oxaliplatin	X
Palbociclib		X
Pentostatin		X
Ponatinib		X
Sunitinib		X
Drugs of abuse
Cocaine		X
Oxymorphone extended release (formulated with PEO, Opana ER)		X
Oxycodone (OxyContin formulated with PEO)		X
Gene therapy
Onasemnogene abeparvovec^*
Hemophilia A
Emicizumab		X
Immunosuppressive therapies
Adalimumab	X
Cyclosporine		X
Everolimus		X
Infliximab		X
Interferons (type 1, alpha and beta)		X
Intravenous immune globulin (IVIG)		X
Sirolimus		X
Tacrolimus		X
Leg cramps, other minor symptoms, malaria (also as a beverage: tonic water, bitter lemon)
Quinine	X

The listed drugs are those that have been reported to have definite (≥1 report) or probable (≥2 reports) evidence for a causal association with DITMA. Published reports often described these syndromes as TTP or HUS. Some drugs that have been commonly reported to be associated with DITMA, such as clopidogrel, do not describe evidence supporting a definite or probable causal association. The presentation and prognosis differ between immune-mediated and toxicity-mediated DITMA. Refer to UpToDate topics on DITMA for details of evaluation and management.

DITMA: drug-induced thrombotic microangiopathy; HUS: hemolytic uremic syndrome; PEO: polyethylene oxide; TMA: thrombotic microangiopathy; TTP: thrombotic thrombocytopenic purpura.

* For rifampin, supporting evidence is lacking; for rifampin and onasemnogene abeparvovec, the proposed mechanism (immune versus non-immune) is unknown.

Data from:

Al-Nouri ZL, Reese JA, Terrell DR, et al. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood 2015; 125:616.
Reese JA, Bougie DW, Curtis BR, et al. Drug-induced thrombotic microangiopathy: Experience of the Oklahoma registry and the BloodCenter of Wisconsin. Am J Hematol 2015; 90:406.
Saleem R, Reese JA, George JN. Drug-induced thrombotic microangiopathy: An updated systematic review, 2014-2018. Am J Hematol 2018; 93:E241.

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Drugs reported to cause drug-induced thrombotic microangiopathy (DITMA)