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Drugs reported to cause drug-induced thrombotic microangiopathy (DITMA)

Drugs reported to cause drug-induced thrombotic microangiopathy (DITMA)
Drug Mechanism
Immune Non-immune
Leg cramps, other minor symptoms, malaria (also as a beverage: tonic water, bitter lemon)
Quinine X  
Cancer therapies
Bevacizumab   X
Bortezomib   X
Carfilzomib   X
Docetaxel   X
Gemcitabine X X
Imatinib   X
Ixazomib   X
Mitomycin   X
Oxaliplatin X  
Palbociclib   X
Pentostatin   X
Ponatinib   X
Sunitinib   X
Antibiotics
Sulfisoxazole X  
Trimethoprim-sulfamethoxazole X  
Hemophilia A
Emicizumab   X
Immunosuppressive therapies
Cyclosporine   X
Everolimus   X
Interferons (type 1, alpha and beta)   X
Intravenous immune globulin (IVIG)   X
Sirolimus   X
Tacrolimus   X
Antiseizure medications
Valproic acid   X
Antipsychotics
Quetiapine X  
Drugs of abuse
Cocaine   X
Oxymorphone extended release (formulated with PEO, Opana ER)   X
Oxycodone (OxyContin formulated with PEO)   X
The listed drugs are those that have been reported to have definite (≥1 report) or probable (≥2 reports) evidence for a causal association with DITMA. Published reports often described these syndromes as TTP or HUS. Some drugs that have been commonly reported to be associated with DITMA, such as clopidogrel, do not describe evidence supporting a definite or probable causal association. The presentation and prognosis differ between immune-mediated and toxicity-mediated DITMA. Refer to UpToDate topics on DITMA for details of evaluation and management.
DITMA: drug-induced thrombotic microangiopathy; TMA: thrombotic microangiopathy; TTP: thrombotic thrombocytopenic purpura; HUS: hemolytic uremic syndrome; PEO: polyethylene oxide.
Data from:
  1. Al-Nouri ZL, Reese JA, Terrell DR, et al. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood 2015; 125:616.
  2. Reese JA, Bougie DW, Curtis BR, et al. Drug-induced thrombotic microangiopathy: Experience of the Oklahoma registry and the BloodCenter of Wisconsin. Am J Hematol 2015; 90:406.
  3. Saleem R, Reese JA, George JN. Drug-induced thrombotic microangiopathy: An updated systematic review, 2014-2018. Am J Hematol 2018; 93:E241.
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