Aplastic anemia is most commonly reported with which antipsychotics?

Aplastic anemia is most commonly reported with which antipsychotics?

• A. Haloperidol and perphenazine
• B. Chlorpromazine and trifluoperazine
• C. Risperidone and quetiapine
• D. Clozapine and olanzapine

Answer: (B)

Aplastic anemia is a rare but serious bone marrow failure that leads to pancytopenia. Among antipsychotics, historical reports repeatedly linked this specific bone marrow suppression to older phenothiazines, especially chlorpromazine, and to trifluoperazine. Because of this classic association, chlorpromazine and trifluoperazine are the best match for the drugs most commonly reported with aplastic anemia. Risperidone and quetiapine are newer (atypical) antipsychotics with hematologic concerns mainly focused on other issues, not aplastic anemia. Clozapine is notorious for agranulocytosis (a severe reduction in neutrophils) rather than aplastic anemia, and olanzapine has far less robust connection to aplastic anemia. Haloperidol and perphenazine have fewer well-documented cases of aplastic anemia compared with the phenothiazines in question. So the historical and magnitude of risk point to chlorpromazine and trifluoperazine as the best answer.

Aplastic anemia is a rare but serious bone marrow failure that leads to pancytopenia. Among antipsychotics, historical reports repeatedly linked this specific bone marrow suppression to older phenothiazines, especially chlorpromazine, and to trifluoperazine. Because of this classic association, chlorpromazine and trifluoperazine are the best match for the drugs most commonly reported with aplastic anemia.

Risperidone and quetiapine are newer (atypical) antipsychotics with hematologic concerns mainly focused on other issues, not aplastic anemia. Clozapine is notorious for agranulocytosis (a severe reduction in neutrophils) rather than aplastic anemia, and olanzapine has far less robust connection to aplastic anemia. Haloperidol and perphenazine have fewer well-documented cases of aplastic anemia compared with the phenothiazines in question.

So the historical and magnitude of risk point to chlorpromazine and trifluoperazine as the best answer.