Valproate & Lower Platelet Count/White Cell Count
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Q:  Can a elderly bipolar patient on Valproic acid & Remeron show a decrease in white blood cell count (leukopenia) & thrombocytopenia due to these drugs?

If so should they be discontinued?

Dear Ms. (or Dr.) D' -- 
Valproate (aka valproic acid or in the U.S., Depakote) can lower platelet counts ("thrombocytopenia") and, less commonly, white cell count decreases. Although I've not heard about this as often, just now checking for a connection with mirtazapine (Remeron), I see reported cases there too (e.g.
this one). What to do about it? Depends on how low the counts are and if there's any trend further downward and whether any symptoms (e.g. easy bleeding) have already shown up and whether there are any additional conditions that would make these low counts a concern. It's the doc's call; there could be some other factors involved as well that I haven't listed here, so it is a tricky decision in some cases. 

Dr. Phelps

Published June, 2006


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