Agranulocytosis Associated With Trandolapril-Verapamil Combination

Abstract

A number of medications have been implicated as potential causes of severe neutropenia or agranulocytosis. A 66-year-old female patient was administered with verapamil-trandolapril for treatment of hypertension. Over three years of verapamil-trandolapril treatment, neutropenia developed. Verapamil-trandolapril was switched to amlodipine and white blood cell count recovered within two months. After a while, amlodipine was switched to ramipril because of the pretibial edema (a side effect of amlodipine); over thirty days neutropenia developed once again. Agranulocytosis is rarely seen due to angiotensin converting enzyme (ACE) inhibitors. Therefore, physicians should be aware of the potential side effects of ACE inhibitors and their combinations on blood cells (especially neutrophils), particularly in patients treated for a long time.