Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature
The possibility of an avian flu pandemic has spurred interest in preventive treatments with antivirals such as oseltamivir. Combining treatment with probenecid to delay excretion may extend limited supplies of oseltamivir. We previously conducted a pharmacokinetic study of oseltamivir plus probeneci...
Published in: | Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy |
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crwiley:10.1592/phco.29.8.988 2024-09-15T17:56:48+00:00 Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature Raisch, Dennis W. Straight, Timothy M. Holodniy, Mark 2009 http://dx.doi.org/10.1592/phco.29.8.988 https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1592%2Fphco.29.8.988 http://onlinelibrary.wiley.com/wol1/doi/10.1592/phco.29.8.988/fullpdf en eng Wiley http://onlinelibrary.wiley.com/termsAndConditions#vor Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy volume 29, issue 8, page 988-992 ISSN 0277-0008 1875-9114 journal-article 2009 crwiley https://doi.org/10.1592/phco.29.8.988 2024-08-27T04:30:07Z The possibility of an avian flu pandemic has spurred interest in preventive treatments with antivirals such as oseltamivir. Combining treatment with probenecid to delay excretion may extend limited supplies of oseltamivir. We previously conducted a pharmacokinetic study of oseltamivir plus probenecid among healthy volunteers. In this article, we describe a 68‐year‐old woman who, during the pharmacokinetic study, developed severe thrombocytopenia 2 weeks after starting oseltamivir plus probenecid. She was receiving no other drug therapy at the time. Her platelet count decreased from 200 to 15 times 10 3 /mm 3 , although no clinically evident bleeding abnormalities were noted. The two drugs were discontinued. One week later, without any therapeutic intervention, her platelet count returned to normal. By using the Naranjo adverse drug reaction probability scale to assess the strength of the association between the drugs and the adverse event, a score of 7 was derived for both drugs, indicating that the association was probable. We found no previous literature reports of thrombocytopenia associated with either drug. However, a review of the United States Food and Drug Administration's Adverse Event Reporting System database found 93 cases of thrombocytopenia and/or decreased platelet counts associated with oseltamivir and 24 cases associated with probenecid administration. Signal detection analyses were significant for oseltamivir (p=0.001), but not probenecid. The underlying mechanism of thrombocytopenia with these drugs is unknown. Clinicians should be aware that the use of oseltamivir and probenecid has been reported to be associated with thrombocytopenia. Article in Journal/Newspaper Avian flu Wiley Online Library Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 29 8 988 992 |
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Wiley Online Library |
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English |
description |
The possibility of an avian flu pandemic has spurred interest in preventive treatments with antivirals such as oseltamivir. Combining treatment with probenecid to delay excretion may extend limited supplies of oseltamivir. We previously conducted a pharmacokinetic study of oseltamivir plus probenecid among healthy volunteers. In this article, we describe a 68‐year‐old woman who, during the pharmacokinetic study, developed severe thrombocytopenia 2 weeks after starting oseltamivir plus probenecid. She was receiving no other drug therapy at the time. Her platelet count decreased from 200 to 15 times 10 3 /mm 3 , although no clinically evident bleeding abnormalities were noted. The two drugs were discontinued. One week later, without any therapeutic intervention, her platelet count returned to normal. By using the Naranjo adverse drug reaction probability scale to assess the strength of the association between the drugs and the adverse event, a score of 7 was derived for both drugs, indicating that the association was probable. We found no previous literature reports of thrombocytopenia associated with either drug. However, a review of the United States Food and Drug Administration's Adverse Event Reporting System database found 93 cases of thrombocytopenia and/or decreased platelet counts associated with oseltamivir and 24 cases associated with probenecid administration. Signal detection analyses were significant for oseltamivir (p=0.001), but not probenecid. The underlying mechanism of thrombocytopenia with these drugs is unknown. Clinicians should be aware that the use of oseltamivir and probenecid has been reported to be associated with thrombocytopenia. |
format |
Article in Journal/Newspaper |
author |
Raisch, Dennis W. Straight, Timothy M. Holodniy, Mark |
spellingShingle |
Raisch, Dennis W. Straight, Timothy M. Holodniy, Mark Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature |
author_facet |
Raisch, Dennis W. Straight, Timothy M. Holodniy, Mark |
author_sort |
Raisch, Dennis W. |
title |
Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature |
title_short |
Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature |
title_full |
Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature |
title_fullStr |
Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature |
title_full_unstemmed |
Thrombocytopenia from Combination Treatment with Oseltamivir and Probenecid: Case Report, MedWatch Data Summary, and Review of the Literature |
title_sort |
thrombocytopenia from combination treatment with oseltamivir and probenecid: case report, medwatch data summary, and review of the literature |
publisher |
Wiley |
publishDate |
2009 |
url |
http://dx.doi.org/10.1592/phco.29.8.988 https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1592%2Fphco.29.8.988 http://onlinelibrary.wiley.com/wol1/doi/10.1592/phco.29.8.988/fullpdf |
genre |
Avian flu |
genre_facet |
Avian flu |
op_source |
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy volume 29, issue 8, page 988-992 ISSN 0277-0008 1875-9114 |
op_rights |
http://onlinelibrary.wiley.com/termsAndConditions#vor |
op_doi |
https://doi.org/10.1592/phco.29.8.988 |
container_title |
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy |
container_volume |
29 |
container_issue |
8 |
container_start_page |
988 |
op_container_end_page |
992 |
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1810432999157661696 |