Pillans P I, Boyd I W
Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2007 Aug;37(8):572-5. doi: 10.1111/j.1445-5994.2007.01408.x.
The objective of this article was the study of 12 cases of granulocytopenia associated with terbinafine use in Australia, the most recent, with agranulocytosis, which is described in detail. The mean age of the participants was 64 years (range 35-79 years). Sex was reported in 11 patients and all but one was a woman. Time to onset of neutropenia/agranulocytosis was 4-5 weeks in most cases. Neutropenia was typically severe with neutrophil counts < or = 0.3 x 10(3)/mm3 in all but 3 of 11 patients where counts were given. Terbinafine was stopped in all patients, five were hospitalized and one died of septic shock. Six patients received antibiotics and three were given granulocyte colony stimulating factor. Terbinafine, indicated for the treatment of onychomycosis and ringworm, may rarely be associated with granulocytopenia, which is typically severe. It takes approximately 1 month or longer for the development of manifestations of neutropenia, which include fatigue, fever, sore throat and mouth ulceration. Withdrawal of terbinafine and appropriate management of febrile neutropenia will probably result in a favourable outcome. Patients should be warned about this potentially life-threatening adverse reaction and the warning symptoms.
本文的目的是研究澳大利亚12例与使用特比萘芬相关的粒细胞减少症病例，其中最新的1例为粒细胞缺乏症，并对其进行详细描述。参与者的平均年龄为64岁（范围35 - 79岁）。11例患者报告了性别，除1例男性外其余均为女性。大多数病例中性粒细胞减少症/粒细胞缺乏症的发病时间为4 - 5周。除11例报告计数的患者中有3例中性粒细胞计数>0.3×10³/mm³外，其余患者的中性粒细胞减少症通常较为严重，中性粒细胞计数≤0.3×10³/mm³。所有患者均停用了特比萘芬，5例住院治疗，1例死于感染性休克。6例患者接受了抗生素治疗，3例接受了粒细胞集落刺激因子治疗。用于治疗甲癣和癣的特比萘芬可能很少与粒细胞减少症相关，粒细胞减少症通常较为严重。中性粒细胞减少症的表现（包括疲劳、发热、咽痛和口腔溃疡）大约需要1个月或更长时间才会出现。停用特比萘芬并对发热性中性粒细胞减少症进行适当处理可能会带来良好的结果。应告知患者这种潜在的危及生命的不良反应及其警示症状。
