We are conducting a research project on adverse drug reactions (ADR) causing admission to the emergency department, and in the evaluation of cases we are employing the EIDOS classification (a mechanistic assessment of ADR) proposed by Aronson and Ferner in 2010.
So, we welcome any information regarding the mechanism of production of the following adverse effects:
Thrombocytopenia associated with valproic acid
Bicytopenia associated with clindamycin
for valproic acid, it is a dose depending thrombocytopenia, that is to say a direct toxicity. For clindamycin,I think it's a immunological mecanism.
To my knowledge, both are unknown. Although, as Frederick stated, there is evidence (1) pointing dose dependant dynamics for valproic acid.
1. Nasreddine W, Beydoun A. Valproate-induced thrombocytopenia: a prospective monotherapy study. Epilepsia 2008;49(3):438–45.
What I know is that thrombocytopenia associated with both valproate and clindamycin is an idiosynchratic reaction.
If i know, trombocytopenia associated with valproic acid has immun mechanism. It may have link with overdose or influence of some provoke factors, for example infection or taking acetylsalicylic acid. The frequency is about 30%, develop on 2-12 week of therapy
Never came across it in my time in platelet immunology, but here is a reference:
Archives of Disease in Childhood, 1982, 57, 681-684
Valproic acid and immune thrombocytopenia
RONALD D BARR, SHIRLEY A COPELAND, MICHELLE L STOCKWELL,
NEIL MORRIS, AND JOHN C KELTON
I did find an valproate -induced red cell autoantibody once!
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