Medication-Induced Erythrocytosis: Common Culprits and Possible Consequences

Secondary erythrocytosis, although more common than primary erythrocytosis, has uncertain consequences and management (especially when the condition arises from prescription drug use). In this systematic review of 45 studies, mostly retrospective, Liu et al. evaluated diagnosis, management, and clinical outcomes of drug-induced erythrocytosis. The analysis focused on testosterone (35 studies) and sodium–glucose cotransporter-2 (SGLT-2) inhibitors (5 studies).

For testosterone, the most common indication was hypogonadism, with reported erythrocytosis rates varying from 0% to 66.7% (highest with intramuscular formulations). Thrombotic complications were rare, and management strategies were heterogenous, and included dose reduction, drug discontinuation, phlebotomy, and anticoagulation. For SGLT-2 inhibitors, rates of erythrocytosis were 2.1% to 22.0%; hemoglobin levels plateaued in some patients, while in others, hemoglobin normalized during drug use or after discontinuation. In the two studies that described thromboembolic events, rates of thrombosis ranged from 6.1% to 10.0%.