Which medication can cause agranulocytosis or aplastic anemia when used for bipolar disorder?

Carbamazepine, commonly known by its brand name Tegretol, is an anticonvulsant medication that is often used in the treatment of bipolar disorder. One of the significant risks associated with carbamazepine is its potential to cause hematological adverse effects, particularly agranulocytosis and aplastic anemia.

Agranulocytosis is a serious condition characterized by a dangerously low level of neutrophils, which are essential for fighting off infections. Aplastic anemia is a condition where the bone marrow fails to produce adequate amounts of blood cells, leading to fatigue, increased infection risk, and bleeding problems. These complications can arise due to the drug’s effects on bone marrow function and immune system modulation.

While other agents used for bipolar disorder, such as lamotrigine, valproic acid, and lithium, have their respective side effects and risks, they are not primarily associated with agranulocytosis or aplastic anemia to the same extent as carbamazepine. This association with serious blood dyscrasias is a critical aspect clinicians consider when prescribing carbamazepine, necessitating regular monitoring of blood counts in patients receiving this medication.