About ITP

Warnings

Below are a list of drugs and other substances that may reduce blood platelet counts in some individuals. Reactions vary.

According to an article by Dr. James George, "Quinidine, quinine, sulfonamides, nonsteroidal anti-inflammatory drugs, and gold compounds were among the most frequently reported drugs..." (that cause thrombocytopenia).See Dr. George's web site for more information on drug-induced thrombocytopenia.

The Blood Center of Southeastern Wisconsin has a laboratory that can test for drug-induced thrombocytopenia and other platelet problems.

(Note: PDSA is in the process of adding references to all of the items on this list. Until that project is complete background information can usually be found by searching the Internet using "substance platelets" or "substance thrombocytopenia" as search criteria)

Drugs that can significantly reduce platelet counts

Major Sources:

[A]Drug Induced Thrombocytopenia
http://moon.ouhsc.edu/jgeorge/DITP.html
[E] The Essential Guide to Prescription Drugs, 1997, James J. Rybacki, Pharm.D. and James W. Long, M.D.

Anxiety/Depression

diazepam [A,E] - antianxiety, tranquilizer (Valium, among others)
chlorpromazine [A] - antipsychotic, tranquilizer (Chlorpromanyl, Largactil, Thorazine)
imipramine [E] - antidepressant (Antipress, Apo-imipramine, Impril, Janimine, Tipramine)
thiothixene [A] (Navane)

Arthritis

penicillamine [E] - antiarthritic, heavy metal poisoning, (Cuprimine, Depen)

Attention Deficit Disorder

methylphenidate hydrochloride (Ritalin) thrombocytopenia purpura is listed as a side-effect

Cancer

levamisole [A,E] (Ergamisol)
interferon alpha [A] (Roferon A, Intron A)
tamoxifen [A] (Nolvadex)

Cholesterol

atorvastatin calcium (lipitor) - binds to plasma proteins See: Atorvastatin-induced severe thrombocytopenia. (Research Letters) Author/s: Maria Luisa Gonzalez-Ponte Issue: Oct 17, 1998 - Lancet

Diabetes

chlorpropamide [A,E] - antidiabetic, (Apo-Chlorpropamide, Chloronase, Diabinese, Glucamide)

Fungus Infection

amphotericin B [A] (Amphocin, Fungizone)

Gout

allopurinol [E] - Used to control gout (Alloprin, Lopurin, Novopurol, Purinol, Zurinol, Zyloprim)

Hair Loss

minoxidil [A,E] - antihypertensive, hair growth stimulant (Minodyl, Minoximen, Rogaine)

Heartburn

cimetidine [A,E] - Heartburn Tagamet, also Zantac, Pepcid in same class of Histamine H-2 blocking drugs
ranitidine [A,E] - H-2 Receptor blocker (Zantac)

Heart Conditions

acetazolamide [E]- Used for glaucoma, seizures, retention of fluid in congestive heart failure, mountain sickness
amiodarone [A,E] (Cordarone)
amrinone [A] (Inocor)
diltiazem [E] - antianginal, antihypertensive, calcium channel blocker (Apo-Diltiaz, Cardizem)
digoxin[A,E] - digitalis preparations, congestive heart stimulant and treatment of heart rhythms. (Lanoxicaps, Lanoxin, Novodigoxin.)
procainamide [A,E] - antiarrhythmic (Apo-Procainamide, Procamide, Procanbid, Promine, Rhythmin)
quinidine [A,E] - antiarrhythmic (Apo-Quinidine, Cardioquin, Duraquin, Quinora)

High Blood Pressure / water retention

chlorothiazide [A,E] - diuretic, antihypertensive (Aldoclor, Diachlor, Diupres, Didudrigen, Diuril, Supres
chlorthalidone [E] - antihypertensive, diuretic (Apo-Chlorthalidone, Combipres, Hygroton-Reserpine, Thalitone, Uridon)
furosemide [E] - antihypertensive, diuretic (Lasix, Lo-Aqua, Luramide)
quinapril hydrochloride (Accupril)

Infections

ampicillin [A,E] - antibiotic used to treat infections (Amcill, Ampicin, Ampilean, Omnipen, Polycillin, Penbritin, Principen)
cephalosporins[E] - anti-infectives
cefaclor (Ceclor), cefadroxil (Duricef, Ultracef), cefamandole (Mandol) cefazolin (Ancef, Kefzol, Zolicef) cefixime (Suprax) cefmetazole (Zefazone), cefonicid (Monocid) cefoperazone (Cefobid) ceforanide (Percef) cefotaxime (Claforan), cefotetan (Cefotan) cefoxitin (Mefoxin) cefprozil (Cefzil) ceftazidime (Fortaz, Tazidime, Tazicef) ceftizoxime (Cefizox), ceftriaxone (Rocephin) cefuroxime (Ceftin, Kefurox, Zinacef) cephalexin (Keflex, Keftab) cephalothin (Keflin) cephapirin (Cefadyl) cephradine (Anspor, Velosef) moxalactam (Moxam) Omnicef
nalidixic acid [A]- (Negram)
penicillin V [E] - antibiotic causes abnormal bleeding or bruising
pentamidine isethionate - (Pentam, NebuPent, Pentacarinate)
rifampin [A,E] - antibiotic (Rifadin, Rifamate, Rofact)
sulfamethoxazole [A]- anti-infective (Apo-Sulfatrim, Bactrim, Comoxol, Septra, etc.)
trimethoprim/sulfamethoxazole [A,E] - anti-infective (Apo-sulfatrim, Bactrim, Coptin, Septra)
vancomycin [A,E] - anti-infective (Vancocin, Vancoled, Vancor)

Inflammation/Pain

acetaminophen [A] (Tylenol, Panadol, others) - considered safe by many, however, some incidences of platelet reduction were found in journal articles.
aspirin [E] (acetylsalicylic acid, ASA) relief of mild to moderate pain and inflammation. Causes decreased number of white blood cells and platelets.
ibuprofen [A] - NSAID
diclofenac [A,E] - analgesic NSAID, (Apo-Diclo, Arthrotec, Cataflam, Novo-difenac,Voltaren)
meclofenamate sodium [A] - NSAID (Meclomen)
morphine [E] - analgesic, opioids
naproxen - NSAID, (Naprosyn)
piroxicam [E] - NSAID, analgesic, (Apo-Piroxicam, Feldene, Novopirocam, Nu-Pirox)
sulfasalazine [A,E] - bowel anti-inflammatory (Azaline, Azulfidine, Salazopyrin)

Malaria

chloroquine [E] - used to treat malaria and amebic infection , causes bone marrow depression (Aralen, Kronofed-A-JR)
hydroxychloroquine (Plaquenil) - antimalarial, immunosuppressant, used in lupus, rheumatoid arthritis, causes bone marrow suppression

Premenstrual Distress

Sarafem

Seizure Disorders

acetazolamide [E] - anticonvulsant (Ak-Zol, Dazamide, Diamox, Storzolamide)
carbamazepine [A,E]- anticonvulsant , reduced formation of all blood cells (Apo-carbamazepine, Epitol, Mazepine, Tegretol).
phenytoin [A,E] - anticonvulsant (Dilantin, Ekko JR, Mebroin, Phelantin)
topiramate - anticonvulsant (Topamax)
valproic acid - anticonvulsant (Depakote, Epival)
zonisamide - (Zonegran) also used for migraine and weight loss

Tuberculosis

isoniazid [A,E] - antituberculosis (Isotamine, Laniazid, Vitamin B-6)
ethambutol [A]- (Myambutol)

Others substances that can reduce the number of platelets

alcohol
alfalfa sprouts (may harbor salmonella)
allicin (contained in Kwai, Kyolic and other garlic supplements)
chlorine
dong quai (angelica sinensis) According to Dr. Hoang, it should be avoided in ITP and autoimmune diseases because it has an estrogenic effect and will make autoimmune conditions worse. He said there is a rule: herbs which stimulate female hormones are contraindicated for autoimmune diseases and those which enhance male hormones and vitality are indicated for autoimmune disease
echinacea
gold and gold salts
Metabalife contains Ma Huang and other substances that interfere with blood clotting (see list below). One of our readers reported a decreased platelet count while using.
niacin (by causing liver problems)
pesticides
phenylpropanolamine (found in decongestants and weight loss products - linked to hemorrhagic strokes) Click for list of products
quinine (found in tonic water and bitter melon)
medications that contain salicylates (ex. Pepto-Bismol, Alka Seltzer)
aminoglutethimide (Cytraden), aminosalicylic acid (Paser), chenodeoxycholic acid, chlorpheniramine, desferrioxamine, diazoxide, diatrizoate meglumine, gentamicin, hydrochlorothiazide, levamisole, lopanoic acid (Telepaque), meprobamate, methyldopa, mianserin, naphazoline (Privine, Vasocon-A), nitrofurantoin, oxprenolol, oxyphenbutazone, phenylbutazone, sodium aminosalicylate, sulfonamidesthioguanine, valproate

Substances that reduce the ability to clot

aspirin
aspartame (can also cause thrombocytopenia)
beer (especially dark beer)
blueberries
chocolate (dark)
chondroitin sulfate (can act like heparin)
coffee 1
vitamin E
feverfew
heparin (can also cause thrombocytopenia)
garlic/onions
gingko biloba (can also reduce the number of platelets)
ginger
ginseng
goldenseal
green tea
guarana
red/purple grape products (grape juice, red wine, raisins)
pycnogenol
Omega 3 fatty acids
SSRI's (Prozac, etc.)
Quercetin, rutin, and related bioflavonoids
ticlopidine (ticlid) used to prevent blood clots
tomatoes
wood ear mushrooms

1 Br J Nutr. 2008 Dec;100(6):1276-82. Epub 2008 Apr 28. http://www.ncbi.nlm.nih.gov/pubmed/18439332