One Case of Agranulocytosis Caused by Tiopronin Enteric-Coated Capsules

doi:10.19803/j.1672-8629.20250724

Abstract

Abstract: Objective To investigate the adverse drug reaction of agranulocytosis caused by tiopronin enteric-coated capsules and provide a reference for safe medication in clinical practice. Methods One case of agranulocytosis induced by tiopronin enteric-coated capsules in a schizophrenia patient with liver injury was analyzed. Related literature was also reviewed and summarized. Results The patient developed liver injury after treatment with paliperidone extended-release tablets. Agranulocytosis accompanied by persistent fever occurred 8 days after combination therapy with tiopronin enteric-coated capsules (0.6 g·d⁻¹) for hepatoprotection. The granulocyte count returned to normal after discontinuation of the suspected drug and symptomatic treatment with anti-infectives, the human granulocyte colony-stimulating factor, and Diyu Shengbai capsules. Conclusion Potential hematologic toxicity, such as agranulocytosis, deserves attention during treatment with tiopronin enteric-coated capsules. When tiopronin is combined with antipsychotics, special attention should be paid to the patient's clinical manifestations and blood routine results.

Key words: Tiopronin, Leukopenia, Agranulocytosis, Paliperidone, Adverse Drug Reaction

CLC Number:

R969.3

DAI Biao, ZHANG Song, DENG Yiyun, CAO Yin, ZHANG Yuanyuan, LI Peipei, LIANG Jun. One Case of Agranulocytosis Caused by Tiopronin Enteric-Coated Capsules[J]. Chinese Journal of Pharmacovigilance, 2026, 23(5): 575-577.

Add to citation manager EndNote|Ris|BibTeX

URL: https://zgywjj.magtechjournal.com/EN/10.19803/j.1672-8629.20250724

https://zgywjj.magtechjournal.com/EN/Y2026/V23/I5/575

References

[1] FANG W, WANG HP, ZHU HX. One Case of Agranulocytosis Caused by Zoledronic Acid Injection[J/OL]. Chinese Journal of Pharmacovigilance(中国药物警戒), (2025-12-16)[2025-12-17]. https://doi.org/10.19803/j.1672-8629.20241010.
[2] Chinese Medical Association Hematology Branch Red Blood Cell Disorders (Anemia) Working Group. Chinese Expert Consensus on the Diagnosis and Treatment of Neutropenia[J]. National Medical Journal of China(中华医学杂志), 2022, 102(40):3167-3173.
[3] LIU X, WANG J, ZHOU TT.Asymptomatic Parotid Gland and Submandibulargland Swelling Caused by Tiopronin:a Case Report[J]. Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2022, 42(20):2198-2200.
[4] TAILLAN B, NECTOUX F, VINTI H, et al.Bone Marrow Aplasia in Rheumatoid Polyarthritis Treated with Tiopronin[J]. Rev Rhum Mal Osteoartic, 1990, 57(5):443-444.
[5] CORDA C, TAVERNIE C, ORIOL P, et al.Tiopronin-Induced Agranulocytosis[J]. Therapie, 1990, 45(2):161.
[6] CHEN JJ, QIAN PP, CAO K, et al.Comparison and Analysis of Causality Assessment Method in China and Naranjo’s Method in the Evaluation of Adverse Drug Reactions[J]. Chinese Pharmaceutical Affairs(中国药事), 2020, 34(8):988-992.
[7] XIE JQ, MA XW, WANG HX.Correlation Analysis of Flurbiprofen Axetil and Hypoxemia Coma Based on Naranjo’s Assessment Scale[J]. China Pharmaceuticals(中国药业), 2023, 32(2):117-119.
[8] DONG QQ, LI XM, CHU FEI, et al.Protective Effect of Acanthopanax Senticosus Injection on the Acute Alcoholic Hepatic Injury in Mice[J]. Journal of Bengbu Medical College(蚌埠医学院学报), 2015, 40(4):421-424.
[9] WEI FQ.Effect of Xuebijing Combined with Tiopronin for Injection in the Treatment of Drug-Induced Liver Injury[J]. China Journal of Pharmaceutical Economics(中国药物经济学), 2024, 19(2):91-93, 98.
[10] MEYLERR A.Meyler’s Side Effects of Drugs:the International Encyclopedia of Adverse Drug Reactions and Interactions[M]. Amsterdam:Elsevier Science, 2015:6389-6391.
[11] SANY J, COMBE B, VERDIEERDIE-PETIBONN D, et al.Long-Term Tolerability of Tiopronin (Acadione) in the Treatment of Rheumatoid Arthritis. Apropos of 140 Personal Cases[J]. Rev Rhum Mal Osteoartic, 1990, 57(2):105-11.
[12] PFAFF AR, BE LTZ J, KING E, et al.Medicinal Thiols:Current Status and New Perspectives[J]. Mini Reviews in Medicinal Chemistry, 2020, 20(6):513-529.
[13] ZHUANG HY, CHEN XP, LIU SS, et al.Clinical Characteristics of 224 Case Reports of Leukopenia Induced by Commonly Used Drugs in the Psychiatry Department[J]. China Pharmaceuticals(中国药业), 2023, 32(6):116-121.
[14] DAI B, CAO Y, SUN YH, et al.808 Cases of Adverse Drug Reactions Caused by Antipsychotic Drugs[J]. Chinese Journal of Pharmaco-vigilance(中国药物警戒), 2025, 22(1):99-103, 108.
[15] ZHANG M, PEI WZ, ZHANG XL.The Effect of Amisulpride on the Ratio of Neutrophilsto Lymphocytes and Abnormal Electrocardiogram in Patients with Schizophrenia[J]. Journal of International Psychiatry(国际精神病学杂志), 2023, 50(5):961-964.
[16] HIROKI M, SOHEI K, IZUMI H, et al.Lithium Carbonate as a Treatment for Paliperidone Extended-Release-Induced Leukopenia and Neutropenia in a Patient with Schizoaffective Disorder; a Case Report[J]. BMC psychiatry, 2016, 16(1):161.