title: Thrombocytopenia following administration of phenytoin, dexamethasone and cimetidine: a case report and a potential mechanism.
abstract: Cimetidine and phenytoin are useful medications often used together in patients with seizure disorders secondary to brain masses or metabolic abnormalities. We describe a case of thrombocytopenia in the setting of concurrent phenytoin, dexamethasone and cimetidine administration, and compare it with previously described cases of thrombocytopenia induced by concurrent use of phenytoin, cimetidine, and glucocorticoids. The similarities between these cases suggest mechanisms by which these agents may induce thrombocytopenia, specifically through potential downregulation of epoxide hydrolase by glucocorticoids.
authors.affiliation: Department of Medicine, Beth Israel Hospital, Boston, Massachusetts.
authors.forename: J L
authors.initials: JL
authors.lastname: Arbiser
authors.forename: A M
authors.initials: AM
authors.lastname: Goldstein
authors.forename: D
authors.initials: D
authors.lastname: Gordon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002927:Cimetidine / Q000009:adverse effects*; D003907:Dexamethasone / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D010672:Phenytoin / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D010672:Phenytoin; D003907:Dexamethasone; D002927:Cimetidine