Agranulocytosis associated with intravenous ritodrine hydrochloride therapy: two case reports by different mechanisms. 2012

Rino Yasuda, and Yasuo Makino, and Yoshio Matsuda, and Yayoi Kawamichi, and Hideo Matsui
Department of Obstetrics and Gynecology, Perinatal Medical Center, Tokyo Women's Medical University Hospital, Tokyo, Japan.

Ritodrine hydrochloride has been widely used for tocolysis, although serious side-effects have been reported. We report two cases of agranulocytosis induced by ritodrine hydrochloride, which probably occurred by different mechanisms. Two patients were hospitalized because of preterm labor and were given intravenous ritodrine hydrochloride. The nadir of neutrocytes was 199/mm(3) and 13/mm(3) in the two cases, respectively. The total dose of ritodrine hydrochloride was calculated to be 7800 mg for 26 days and 2500 mg for 22 days, respectively. The total doses were heavier and administration duration was longer in Case 1, which suggested a toxic mechanism of agranulocytosis, while in Case 2, they were smaller and shorter, suggesting an immunological mechanism. For patients receiving ritodrine hydrochloride, the white blood cell count should be checked frequently regardless of the duration of therapy and a drug lymphocyte stimulation test should be performed.

UI MeSH Term Description Entries
D007752 Obstetric Labor, Premature Onset of OBSTETRIC LABOR before term (TERM BIRTH) but usually after the FETUS has become viable. In humans, it occurs sometime during the 29th through 38th week of PREGNANCY. TOCOLYSIS inhibits premature labor and can prevent the BIRTH of premature infants (INFANT, PREMATURE). Preterm Labor,Labor, Premature,Premature Labor,Premature Obstetric Labor,Labor, Premature Obstetric,Labor, Preterm
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000380 Agranulocytosis A decrease in the number of GRANULOCYTES; (BASOPHILS; EOSINOPHILS; and NEUTROPHILS). Granulocytopenia,Agranulocytoses,Granulocytopenias
D012312 Ritodrine An adrenergic beta-2 agonist used to control PREMATURE LABOR. DU-21220,Pre-Par,Ritodrine Hydrochloride,Yutopar,DU 21220,DU21220,Hydrochloride, Ritodrine,Pre Par,PrePar
D015149 Tocolytic Agents Drugs that prevent preterm labor and immature birth by suppressing uterine contractions (TOCOLYSIS). Agents used to delay premature uterine activity include magnesium sulfate, beta-mimetics, oxytocin antagonists, calcium channel inhibitors, and adrenergic beta-receptor agonists. The use of intravenous alcohol as a tocolytic is now obsolete. Tocolytic,Tocolytic Agent,Tocolytic Effect,Tocolytic Effects,Tocolytics,Agent, Tocolytic,Agents, Tocolytic,Effect, Tocolytic,Effects, Tocolytic

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