Am J Psychiatry 1995; 152:413-418
Copyright © 1995 by American Psychiatric Association
Blood dyscrasias with carbamazepine and valproate: a pharmacoepidemiological study of 2,228 patients at risk
M Tohen, J Castillo, RJ Baldessarini, C Zarate Jr and JC Kando
Consolidated Department of Psychiatry, Harvard Medical School, Boston, MA.
OBJECTIVE: The purpose of this study was to determine the occurrence of
leukopenia and other blood dyscrasias associated with psychiatric use of
carbamazepine and valproate. METHOD: Rates of WBC counts of 3,000-
4,000/mm3 (moderate leukopenia) and < 3,000/mm3 (severe leukopenia),
platelet counts of < 100,000/mm3, and hematocrit < 30% were
identified among 2,228 treated patients at risk among 11,720 patients
admitted to McLean Hospital over 4 years (1989-1993). Patients who received
carbamazepine or valproate and had a blood dyscrasia not associated with a
relevant medical condition were compared to patients treated with
imipramine or desipramine. RESULTS: Of 977 patients treated with
carbamazepine, 2.1% experienced leukopenia (16 moderate cases, five
severe). Time to 50% risk was 16 days, and recovery occurred within about 6
days after carbamazepine was stopped. For 1,251 patients given valproate,
the occurrence of leukopenia was 0.4% (three moderate cases, two severe).
The occurrence of leukopenia in 1,031 patients given the tricyclic
antidepressants was 0.3% (two moderate cases, one severe). The observed
occurrence of moderate leukopenia with carbamazepine was 6.9 and 7.3 times
higher than that with valproate and antidepressants, respectively.
CONCLUSIONS: Severe blood dyscrasias were uncommon in psychiatric patients
given carbamazepine and were about as rare with valproate as with
imipramine or desipramine. Most important, in this cohort of 2,228 patients
exposed to carbamazepine and valproate, there were no life-threatening
cases.
