CASE REPORT article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1637065
This article is part of the Research TopicEvidence for Assessing Drug Safety and Drug Use in Older People: Volume IIIView all articles
Drug-induced severe sideroblastic anemia following combined olanzapine and fluvoxamine therapy: a case report
Provisionally accepted
- 1浙江中医药大学, Hangzhou, China
- 2Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou, China
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Abstract: Olanzapine and fluvoxamine are commonly used psychotropic medications for treating anxiety and depressive disorders, particularly in cases with psychotic symptoms or treatment-resistant presentations. Although there are occasional reports of hematologic toxicity with monotherapy of these two drugs, no clear reports in the existing literature have documented severe sideroblastic anemia induced by their combination. Notably, as a potent CYP1A2 inhibitor, fluvoxamine significantly inhibits the metabolism of olanzapine, leading to elevated plasma concentrations. This pharmacokinetic synergy may exacerbate the risk of myelosuppression, although the specific mechanism remains to be elucidated. This article presents the first documented case of a 78-year-old male patient with chronic obstructive pulmonary disease (COPD) who developed severe anemia (nadir hemoglobin 37 g/L) after the combined use of olanzapine and fluvoxamine. Through systematic etiological investigation, bone marrow morphology findings, and the Naranjo Adverse Drug Reaction Probability Scale (score 9, indicating a clear association), the diagnosis was confirmed as drug-induced severe acquired sideroblastic anemia. This case underscores the importance of thoroughly evaluating blood system safety when combining psychotropic medications in elderly patients with chronic diseases, and highlights the need for enhanced dynamic monitoring to identify and intervene in potential adverse reactions at an early stage.
Keywords: olanzapine, Fluvoxamine, sideroblastic anemia, Severe anemia, Drug Interactions
Received: 28 May 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Zhang, Zhang, Zhang and Hu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dandan Hu, Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou, China
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