Some medications and other substances associated with pancytopenia

Category	Examples
Nonsteroidal anti-inflammatory drugs	Aspirin Diclofenac Ibuprofen Indomethacin Phenylbutazone* Salicylates Sulindac
Anti-gout	Allopurinol Colchicine
Antimicrobials (including antiviral, antihelmintic, and antimalarial)	Albendazole Chloramphenicol^¶ Cidofovir Dapsone Foscarnet Ganciclovir Linezolid^Δ Quinidine Quinine Sulfonamides (eg, sulfamethoxazole, sulfisoxazole) Zidovudine
Anti-epileptics	Carbamazepine Fosphenytoin Felbamate Levetiracetam Phenytoin Phenobarbital Valproate
Anti-thyroid	Methimazole Propylthiouracil
Cardiovascular (also refer to diuretics)	Aspirin Amiodarone Captopril Lisinopril Nifedipine Quinidine Ticlopidine*
Chelating	Penicillamine
Diuretics	Acetazolamide Furosemide Thiazides
Endocrine	Refer to anti-thyroid above
Immunosuppressant (anti-rejection therapy in solid organ transplantation)	Azathioprine^◊
Gastrointestinal (acid suppression)	Cimetidine Nizatidine
Gastrointestinal (inflammatory bowel disease)	Azathioprine^◊ Mercaptopurine^◊ Mesalamine Sulfasalazine
Psychiatric	Bupropion Carbamazepine Lithium Valproate
Rheumatologic (also refer to anti-gout)	Azathioprine^◊ Gold sodium thiomalate and other gold salts* Leflunomide Methotrexate Penicillamine Sulfasalazine
Travel medicine (altitude sickness)	Acetazolamide
Other exposures	Benzene MDMA (ecstasy) Glue vapors Pesticides Radiation Solvents, organic

This table does not report all medications that have been associated with pancytopenia. In some cases, the report of an association between a medication and cytopenias does not prove causality. Refer to accompanying text for details.
Directly cytotoxic chemotherapeutic agents are omitted from this list, as myelosuppression is an anticipated effect. However, immune-mediated pancytopenia has been rarely associated with some directly cytotoxic agents (eg, platinum-based chemotherapy).

* Not available in the United States; may have limited availability in other countries.
¶ Dose-related reversible bone-marrow suppression is frequently seen with use of chloramphenicol. A rare, non-dose-related form of severe and often fatal aplastic anemia can also occur in about 1 in 20,000 treated patients; as a result, use of chloramphenicol is restricted in many countries. Systemic absorption from ophthalmic use can reportedly occur, but the incidence of serious hematologic toxicity appears to be very low.
Δ Risk factors for linezolid-induced myelosuppression include renal impairment, low baseline blood cell counts, and duration of therapy >14 days.
◊ Azathioprine is a prodrug of mercaptopurine, and both have been associated with aplastic anemia in patients with very low or absent thiopurine methyltransferase (TPMT) enzyme activity. Refer to the UpToDate clinical review of 6-mercaptopurine metabolite monitoring and TPMT testing for additional details.

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Some medications and other substances associated with pancytopenia