Cyanamide-induced aplastic anemia

  • Elena Ballarín
  • Luisa Ibáñez
  • José-Angel Hernández
  • Lluís Force
  • Joan-Ramon Laporte
Short Communication

Abstract

Objective

To report a case of aplastic anemia in a patient treated with cyanamide, an alcohol-aversive drug.

Case summary

A 67-year-old man was admitted to hospital because of fever and pancytopenia. He had taken cyanamide for 6 months as an alcohol deterrent. No other risk factors for aplastic anemia were identified by interviewing the patient using a structured validated questionnaire. The results of bone-marrow biopsy showed severe aplastic anemia. Cyanamide was discontinued and the patient was treated according to a prespecified treatment protocol. One year after hospital admission, the patient was completely recovered with no need of immunosuppressive therapy. An objective causality assessment revealed that an adverse drug reaction was probable.

Discussion

As the efficacy of cyanamide has been questioned, due to the failure of various trials to show any benefit over placebo, its overall benefit/risk ratio should be reconsidered. The complete and rapid hematological recovery after discontinuation of the drug, and the absence of other factors that could explain the condition support the association of the present case of aplastic anemia with cyanamide. The mechanism remains unknown. Aplastic anemia is a rare but potentially serious adverse drug effect of cyanamide treatment.

Conclusions

Given the poor evidence on the efficacy of cyanamide and the associated risk of aplastic anemia, its use in reducing alcohol consumption should be reconsidered.

Keywords

Cyanamide Aplastic anemia Pharmacovigilance Adverse drug reaction 

References

  1. 1.
    Peachey JE, Annis HM, Bornstein ER, Sykora K, Maglana SM, Shamai S (1989) Calcium carbimide in alcoholism treatment: part 1. A placebo-controlled, double-blind clinical trial of short-term efficacy. Br J Addict 84:877–887PubMedGoogle Scholar
  2. 2.
    Ozdeimer V, Busto U, Einarson T, Lanctot KL, Naranjo CA (1994) Meta-analysis of the efficacy of alcohol-sensitizing agents in alcohol dependence (abstract). Clin Pharmacol Ther 55:134Google Scholar
  3. 3.
    Swift RM (1999) Drug therapy for alcohol dependence. N Engl J Med 340:1482–1490PubMedGoogle Scholar
  4. 4.
    Reilly TM (1976) Peripheral neuropathy associated with citrated calcium carbimide. Lancet 24:911–912Google Scholar
  5. 5.
    Vázquez JJ, Cervera S (1980) Cyanamide-induced liver injury in alcoholics. Lancet 16:361–362Google Scholar
  6. 6.
    Suzuki Y, Yokoyama A, Nakano M, Okuyama K, Takahashi H, Tamai H et al (2000) Cyanamide-induced liver dysfunction after abstinence in alcoholics: a long-term follow-up study on four cases. Alcohol Clin Exp Res 24:100S–105SPubMedGoogle Scholar
  7. 7.
    Anonymous (1997) Reacciones adversas respiratorias notificadas en Andalucía. Alerta de Farmacovigilancia 15:13–15Google Scholar
  8. 8.
    Ajima M, Usaki K, Igarashi A, Okazaki R, Hamano K, Urabe A et al (1997) Cyanamide-induced granulocytopenia. Intern Med 36:640–642PubMedGoogle Scholar
  9. 9.
    Morales A, Sanchez JJ, Funes C, Sanz E (1990) Agranulocytosis related to calcium cyanamide (Colme). Sangre (Barc) 35(5):412Google Scholar
  10. 10.
    Ríos E, Carrasco V, López D, Díez JL (1992) Aplastic anemia and cyanamide. Eur J Haematol 48:179PubMedGoogle Scholar
  11. 11.
    Prieto C, Pérez C, Rodríguez A, Martínez R, del Potro E, Álvarez A (2000) Relapsing pancytopenia following exposure and re-exposure to cyanamide. Eur J Haematol 65:414–415PubMedGoogle Scholar
  12. 12.
    Sweetman SC, Martindale (2005) The complete drug reference, 33rd edn. Pharmaceutical Press, LondonGoogle Scholar
  13. 13.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA et al (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245PubMedGoogle Scholar
  14. 14.
    Kaufman DW, Kelly JP, Levy M, Shapiro S (1991) The drug etiology of agranulocytosis and aplastic anemia. Oxford University Press, New YorkGoogle Scholar
  15. 15.
    Laporte JR, Ibáñez L, Ballarín E, Pérez E, Vidal X (1998) Fatal aplastic anaemia associated with nifedipine. Lancet 352:619–620PubMedGoogle Scholar
  16. 16.
    Levy MS, Livingstone BL, Collins MD (1967) A clinical comparison of disulfiram and calcium carbimide. Am J Psychiatry 123:1018–1922PubMedGoogle Scholar
  17. 17.
    Pachey JE, Zilm DH, Cappell H (1981) “Burning off the antabuse”: fact or fiction? Lancet 1:943–944PubMedGoogle Scholar
  18. 18.
    Pachey JE, Zilm DH, Robinson GM (1983) A placebo-controlled double-blind comparative clinical study of the disulfiram and calcium carbimide-acetaldehyde-mediated ethanol reactions in social drinkers. Alcohol Clin Exp Res 7:180–187Google Scholar
  19. 19.
    Annis HM, Peachy JE (1992) The use of calcium carbimide in relapse prevention counselling: results of a randomized controlled trial. Br J Addict 87:63–72PubMedGoogle Scholar
  20. 20.
    Edwards G, Taylor C (1994) A test of the matching hypothesis: alcohol dependence, intensity of treatment, and 12-month outcome. Addiction 89:553–561PubMedGoogle Scholar
  21. 21.
    Niederhofer H, Staffen W, Mair A (2003) Comparison of cyanamide and placebo in the treatment of alcohol dependence of adolescents. Alcohol Alcohol 38:50–53PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Elena Ballarín
    • 1
  • Luisa Ibáñez
    • 1
  • José-Angel Hernández
    • 2
  • Lluís Force
    • 3
  • Joan-Ramon Laporte
    • 1
  1. 1.Fundació Institut Català de Farmacologia Servei de Farmacologia ClínicaHospital Universitari Vall d’Hebron Universitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Hematology DepartmentHospital de MataróMataróSpain
  3. 3.Internal Medicine DepartmentHospital de MataróMataróSpain

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