A 75-year-old woman was acutely referred to the geriatric clinic with haemoglobine of 60 and low le

Fråga: A 75-year-old woman was acutely referred to the geriatric clinic with haemoglobine of 60 and low levels of leucocytes. For 45 years she has been treated with Mylepsin 250 mg twice daily for an absence epilepsy. It is not known whether the patient has been controlled by serum concentration determinations. No samples have been analysed at this laboratory. Can the anaemia and leucopenia be due to treatment with Mylepsin?

Sammanfattning: Haematological side effects of primidone have only been rarely reported. Other causes of anaemia and leucopenia must be sought before primidone can be primarily suspected to be the cause of the patients condition.

Svar: A question concerning leucopenia and thrombocytopenia in a patient treated with carbamazepine and primidone has previously been answered in Drugline. It is stated that thrombocytopenia as well as leucopenia has been reported in a single case (1). In the Swedish side effect register, SWEDIS, there are eight reports of haematological side effects, seven of which are megaloblastic anaemia and one case of myelofibrotic anaemia (2). In one recent case report agranulocytosis was reported in which a patient had taken primidone and phenytoin for approximately 17 years (3). Taking into consideration the many other possibilities of anaemia and leucopenia, other causes of these findings must be considered before primidone can be primarily suspected to be the cause of the patient´s problems. If other causes can be excluded the case should be reported to the regional side effect register in Stockholm.