A 70-year-old Japanese woman with renal dysfunction under
hemodialysis presented with
vomiting and chill with
fever. Over the previous 24 weeks she had been taking 75 mg of
ranitidine after
hemodialysis. Other medications taken were
prednisolone,
furosemide, alpha-calcidol,
amlodipine and
calcium carbonate. Before starting
ranitidine, she had been treated with
famotidine for about 2 years without complication. Hematological inspection on admission revealed
agranulocytosis with WBC of 400/mm3.
Ranitidine was discontinued and
granulocyte colony-stimulating factor (
G-CSF) was started. On Day 3, laboratory data showed slight improvement of
cytopenia with WBC of 1,000/mm3. On Day 6, her hemogram showed marked improvement with WBC of 11,700/mm3 and
G-CSF was discontinued. She was discharged on Day 10. Several cases describing
ranitidine-induced
cytopenia are associated with the use of
ranitidine at a dose of 150 mg/day or higher, and adverse reactions were found within 2-35 days after beginning
ranitidine treatment. In the case described here, however, the adverse reaction occurred after a longer treatment period with
ranitidine at a lower dose. In conclusion,
ranitidine should be administered with great caution to patients with severe renal dysfunction.