Zhang Xinru, Zhang Anan, Zhang Jinmei, Hu Dandan
The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Front Psychiatry. 2025 Sep 5;16:1637065. doi: 10.3389/fpsyt.2025.1637065. eCollection 2025.
Olanzapine and fluvoxamine are commonly used psychotropic medications for treating anxiety and depressive disorders, particularly in cases with psychotic symptoms or treatment-resistant presentations. Although there are occasional reports of hematologic toxicity with monotherapy of these two drugs, no clear reports in the existing literature have documented severe sideroblastic anemia induced by their combination. Notably, as a potent CYP1A2 inhibitor, fluvoxamine significantly inhibits the metabolism of olanzapine, leading to elevated plasma concentrations. This pharmacokinetic synergy may exacerbate the risk of myelosuppression, although the specific mechanism remains to be elucidated. This article presents the first documented case of a 78-year-old male patient with chronic obstructive pulmonary disease (COPD) who developed severe anemia (nadir hemoglobin 37 g/L) after the combined use of olanzapine and fluvoxamine. Through systematic etiological investigation, bone marrow morphology findings, and the Naranjo Adverse Drug Reaction Probability Scale (score 9, indicating a clear association), the diagnosis was confirmed as drug-induced severe acquired sideroblastic anemia. This case underscores the importance of thoroughly evaluating blood system safety when combining psychotropic medications in elderly patients with chronic diseases, and highlights the need for enhanced dynamic monitoring to identify and intervene in potential adverse reactions at an early stage.
奥氮平和氟伏沙明是常用的精神药物，用于治疗焦虑症和抑郁症，特别是伴有精神病症状或难治性表现的病例。虽然偶尔有关于这两种药物单药治疗引起血液学毒性的报道，但现有文献中尚无明确报道记录其联合使用导致严重的铁粒幼细胞贫血。值得注意的是，作为一种强效的CYP1A2抑制剂，氟伏沙明可显著抑制奥氮平的代谢，导致血浆浓度升高。这种药代动力学协同作用可能会加剧骨髓抑制的风险，尽管具体机制仍有待阐明。本文报道了首例有记录的78岁男性慢性阻塞性肺疾病（COPD）患者，在联合使用奥氮平和氟伏沙明后出现严重贫血（最低血红蛋白37g/L）。通过系统的病因调查、骨髓形态学检查结果以及Naranjo药物不良反应概率量表（评分9分，表明明确关联），确诊为药物性严重获得性铁粒幼细胞贫血。该病例强调了在老年慢性病患者联合使用精神药物时全面评估血液系统安全性的重要性，并突出了加强动态监测以早期识别和干预潜在不良反应的必要性。
