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(Agranulocytosis; Granulocytopenia)


David C. Dale

, MD, University of Washington

Reviewed/Revised Apr 2023
Topic Resources

Neutropenia is a reduction in the blood neutrophil count. If it is severe, the risk and severity of bacterial and fungal infections increase. Focal symptoms of infection may be muted, but fever is present during most serious infections. Diagnosis is by white blood cell count with a differential count, and evaluation requires identification of the cause. If fever is present, infection is presumed, and immediate, empiric broad-spectrum antibiotics are necessary, especially if the neutropenia is severe. Treatment with granulocyte colony-stimulating factor is used to stimulate neutrophil production and prevent bacterial infections after cancer chemotherapy and with severe chronic neutropenia.

The normal lower limit of the neutrophil count (total white blood cell count × % neutrophils and bands) is 1500/mcL (1.5 × 109/L) in White patients and is somewhat lower in Black patients (about 1200/mcL [1.2 × 109/L). Neutrophil counts are not as stable as other cell counts and may vary considerably over short periods, depending on many factors such as activity status, anxiety, infections, and medications taken. Thus, several measurements may be needed when determining the severity of neutropenia.

Severity of neutropenia relates to the relative risk of infection and is classified as follows:

  • Mild: 1000 to 1500/mcL (1 to 1.5 × 109/L)

  • Moderate: 500 to 1000/mcL (0.5 to 1 × 109/L)

  • Severe: < 500/mcL (< 0.5 × 109/L)

When neutrophil counts fall to < 500/mcL, endogenous microbial flora (eg, in the mouth or gut) can cause infections. If the count falls to < 200/mcL (< 0.2 × 109/L), the inflammatory response may be muted, and the usual inflammatory findings of leukocytosis or white blood cells in the urine or at the site of infection may not occur. Acute, severe neutropenia, particularly if another factor (eg, cancer) is present, significantly impairs the immune system and can lead to rapidly fatal infections. The integrity of the skin and mucous membranes, the vascular supply to tissue, and the nutritional status of the patient also influence the risk of infections.

The most frequently occurring infections in patients with profound neutropenia are

Etiology of Neutropenia

Acute neutropenia (occurring over hours to a few days) can develop as a result of

  • Rapid neutrophil use or destruction

  • Impaired neutrophil production

Chronic neutropenia (lasting months to years) usually arises as a result of

  • Reduced production

  • Excessive splenic sequestration

Neutropenia also may be classified as

  • Primary due to an intrinsic defect in marrow myeloid cells

  • Secondary due to factors extrinsic to marrow myeloid cells


Neutropenia caused by intrinsic defects in myeloid cells or their precursors

  • Chronic idiopathic neutropenia

  • Congenital neutropenia

Chronic idiopathic neutropenia is a type of chronic neutropenia in which the rest of the immune system appears to remain intact. Even when neutrophil counts are < 200/mcL (< 0.2 × 109/L), severe infections are infrequent, probably because neutrophils are produced in adequate quantities in response to infection. It is more common in women.

Severe congenital neutropenia (SCN) is a heterogenous group of rare disorders that are characterized by an arrest in myeloid maturation at the promyelocyte stage in the bone marrow, resulting in an absolute neutrophil count of < 200/mcL (< 0.2 × 109/L) and significant infections starting in infancy. Severe congenital neutropenia is usually inherited in an autosomal dominant fashion but can be recessive, X-linked, or sporadic.

Cyclic neutropenia is a rare congenital granulocytopoietic disorder, usually transmitted in an autosomal dominant fashion and usually caused by a mutation in the gene for neutrophil elastase (ELANE), that results in apoptosis. It is characterized by regular, periodic oscillations in the number of peripheral neutrophils. The mean oscillatory period is 21 ± 3 days. Cycling of other blood cells is also evident in most cases.

Benign ethnic neutropenia occurs in members of some ethnic groups (eg, some people of African, Middle Eastern, or Jewish ancestry). Patients normally have lower neutrophil counts but do not have increased risk of infection. In some cases, this finding has been linked to the Duffy red blood cell antigen; some experts think neutropenia in these populations is related to protection from malaria Malaria Malaria is infection with Plasmodium species. Symptoms and signs include fever (which may be periodic), chills, rigors, sweating, diarrhea, abdominal pain, respiratory distress, confusion... read more Malaria .

Rare congenital syndromes (eg, cartilage-hair hypoplasia syndrome, Chédiak-Higashi syndrome Chédiak-Higashi Syndrome Chédiak-Higashi syndrome is a rare, autosomal recessive immunodeficiency disorder characterized by impaired lysis of phagocytized bacteria, resulting in recurrent bacterial respiratory and other... read more , dyskeratosis congenita, glycogen storage disease type Ib, Shwachman-Diamond syndrome, warts, hypogammaglobulinemia, infections, myelokathexis [WHIM] syndrome) can involve bone marrow failure that causes neutropenia.

Secondary neutropenia

Secondary neutropenia can result from use of certain drugs, bone marrow infiltration or replacement, certain infections, or immune reactions.

The most common causes include

  • Drugs

  • Infections and immune reactions

  • Marrow infiltrative processes

Drug-induced neutropenia is one of the most common causes of neutropenia. Drugs can decrease neutrophil production through toxic, idiosyncratic, or hypersensitivity mechanisms; or they can increase peripheral neutrophil destruction through immune mechanisms. Only the toxic mechanism causes dose-related neutropenia.

Severe dose-related neutropenia occurs predictably after administration of cytotoxic cancer drugs, phenothiazine, or radiation therapy due to suppression of bone marrow production.

Idiosyncratic reactions are unpredictable and occur with a wide variety of drugs, including alternative medicine preparations or extracts, and toxins.

Immune-mediated drug-induced neutropenia, thought to arise from drugs that act as haptens to stimulate antibody formation, usually persists for about 1 week after the drug is stopped. It may result from aminopyrine, clozapine, propylthiouracil and other antithyroid drugs, penicillin, or other antibiotics.

Infections can cause neutropenia by impairing neutrophil production or by inducing immune destruction or rapid turnover of neutrophils. Sepsis Sepsis and Septic Shock Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure... read more is a particularly serious cause. Neutropenia that occurs with common childhood viral diseases develops during the first 1 to 2 days of illness and may persist for 3 to 8 days. Transient neutropenia may also result from virus- or endotoxemia-induced redistribution of neutrophils from the circulating to the marginal pool. Alcohol may contribute to neutropenia by inhibiting the neutrophilic chemotactic response of the marrow during some infections (eg, pneumococcal pneumonia).

Immune defects can cause neutropenia. Neonatal isoimmune neutropenia can occur with fetal/maternal neutrophil antigen incompatibility associated with transplacental transfer of IgG antibodies against the newborn’s neutrophils (most commonly to human neutrophil antigen [HNA-1]). Autoimmune neutropenia can occur at any age and may be operative in many cases of idiopathic chronic neutropenia. Testing for antineutrophil antibodies (immunofluorescence, agglutination, or flow cytometry) is not always available or reliable.

Autoimmune neutropenias may be acute, chronic, or episodic. They may involve antibodies directed against circulating neutrophils or neutrophil precursor cells. They may also involve cytokines (eg, gamma interferon, tumor necrosis factor) that can cause neutrophil apoptosis. Most patients with autoimmune neutropenia have an underlying autoimmune disorder or lymphoproliferative disorder (eg, large granular lymphocyte [LGL syndrome [a clonal disease of large granular lymphocytes], systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Common manifestations may include arthralgias and... read more Systemic Lupus Erythematosus (SLE) , Felty syndrome). Chronic secondary neutropenia often accompanies HIV infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection results from 1 of 2 similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ lymphocytes and impair cell-mediated immunity, increasing risk of certain... read more Human Immunodeficiency Virus (HIV) Infection because of impaired production of neutrophils and accelerated destruction of neutrophils by antibodies.

Etiology references

  • 1. Dale DC: How I diagnose and treat neutropenia. Curr Opin Hematol 23(1):1-4, 2016. doi: 10.1097/MOH.0000000000000208

  • 2. Skokowa J, Dale DC, Touw IP, et al: Severe congenital neutropenias. Nat Rev Dis Primers 3:17032, 2017. doi: 10.1038/nrdp.2017.32

Symptoms and Signs of Neutropenia

Neutropenia is asymptomatic until infection develops. Fever is often the only indication of infection. If neutropenia is severe, typical signs of focal inflammation (erythema, swelling, pain, infiltrates) may be muted or absent. Focal symptoms (eg, oral ulcers) may develop but are often subtle. Patients with drug-induced neutropenia due to hypersensitivity may have a fever, rash, and lymphadenopathy as a result of the hypersensitivity reaction.

Some patients with chronic idiopathic neutropenia and neutrophil counts < 200/mcL (< 0.2 × 109/L) do not experience many serious infections. Patients with cyclic neutropenia or severe congenital neutropenia tend to have episodes of oral ulcers, stomatitis, or pharyngitis and lymph node enlargement during severe neutropenia. Pneumonias and sepsis often occur.

Diagnosis of Neutropenia

  • Clinical suspicion (repeated or unusual infections)

  • Confirmatory complete blood count (CBC) with differential

  • Evaluation for infection with cultures and imaging

  • Identification of mechanism and cause of neutropenia

Neutropenia is suspected in patients with frequent, severe, or unusual infections or in patients at risk (eg, those receiving cytotoxic drugs or radiation therapy). Confirmation is by CBC with a differential count.

Evaluation for infection

The first priority is to determine whether an infection is present. Because infection may be subtle, physical examination systematically assesses the most common primary sites of infection:

  • Mucosal surfaces, such as the alimentary tract (gums, pharynx, anus)

  • Sinuses

  • Lungs

  • Abdomen

  • Urinary tract

  • Skin and fingernails

  • Venipuncture sites

  • Vascular catheters

If neutropenia is acute or severe, laboratory evaluation must proceed rapidly.

Cultures are the mainstay of evaluation. At least 2 sets of samples for bacterial and fungal blood cultures are obtained from all febrile patients. If an indwelling IV catheter is present, samples are drawn from the catheter and from a separate peripheral vein. Persistent or chronic drainage material is also cultured for bacteria, fungi, and atypical mycobacteria. Mucosal ulcers are swabbed and cultured for herpes virus and Candida. Skin lesions are aspirated or biopsied for cytology and culture. Samples for urinalysis and urine cultures are obtained from all patients. If diarrhea is present, stool is evaluated for enteric bacterial pathogens and Clostridioides (formerly Clostridium) difficile toxins. Sputum cultures are obtained to evaluate for pulmonary infections.

Imaging studies are helpful. Chest x-rays are done on all patients. A chest CT may also be necessary in patients with neutropenia. CT of the paranasal sinuses may be helpful if symptoms or signs of sinusitis (eg, positional headache, upper tooth or maxillary pain, facial swelling, nasal discharge) are present. CT scan of the abdomen is usually done if symptoms (eg, pain) or history (eg, recent surgery) suggests an intra-abdominal infection.

Identification of cause

Next, the mechanism and cause of neutropenia are determined. The history addresses family history, presence of other disorders, all medications or other preparations being taken, pets, and possible toxin exposure or ingestion.

Physical examination addresses the presence of splenomegaly Splenomegaly Splenomegaly is abnormal enlargement of the spleen. (See also Overview of the Spleen.) Splenomegaly is almost always secondary to other disorders. Causes of splenomegaly are myriad, as are the... read more , lymphadenopathy, skin lesions (eg, areas of erythema, macules, papules, pustules), and signs of other underlying disorders (eg, arthritis).

If no obvious cause is identified (eg, chemotherapy), the most important test is

  • Bone marrow examination

Differentiation between neutropenia caused by certain antibiotics and infection can sometimes be difficult. The white blood cell count just before the start of antibiotic treatment usually reflects the change in blood count due to the infection.

Patients who have had chronic neutropenia since infancy and a history of recurrent fevers and chronic gingivitis should have white cell counts with differential done 3 times/week for 6 weeks, so that periodicity suggestive of cyclic neutropenia can be evaluated. Platelet and reticulocyte counts are done simultaneously. In patients with cyclic neutropenia, eosinophils, reticulocytes, and platelets frequently cycle synchronously with the neutrophils, whereas monocytes and lymphocytes may cycle out of phase.

Molecular genetic testing for ELANE and other genes is appropriate when congenital causes are considered.

Treatment of Neutropenia

  • Treatment of associated conditions (eg, infections, stomatitis)

  • Sometimes antibiotic prophylaxis

  • Myeloid growth factors

  • Discontinuation of suspected etiologic agent (eg, drug)

  • Sometimes corticosteroids

Acute neutropenia

Suspected infections are always treated immediately. If fever or hypotension is present, serious infection is assumed, and empiric, high-dose, broad-spectrum antibiotics are given IV. Regimen selection is based on the most likely infecting organisms, the antimicrobial susceptibility of pathogens at that particular institution, and the regimen’s potential toxicity. Because of the risk of creating resistant organisms, vancomycin is used only if gram-positive organisms resistant to other drugs are suspected.

Indwelling vascular catheters can usually remain in place even if bacteremia is suspected or documented, but removal is considered if infections involve S. aureus, Bacillus, Corynebacterium, or Candida or another fungus or if blood cultures are persistently positive despite appropriate antibiotics. Infections caused by coagulase-negative staphylococci generally resolve with antimicrobial therapy alone.

Indwelling Foley catheters can also predispose to infections in neutropenic patients, and change or removal of the catheter should be considered for persistent urinary infections.

If cultures are positive, antibiotic therapy is adjusted to the results of sensitivity tests. If a patient defervesces within 72 hours, antibiotics are continued for at least 7 days and until the patient has no symptoms or signs of infection. When neutropenia is transient (such as that following myelosuppressive chemotherapy), antibiotic therapy is usually continued until the neutrophil count is > 500/mcL (> 0.5 × 109/L); however, if cultures remain negative, stopping antimicrobials can be considered in selected patients with persistent neutropenia, especially those in whom symptoms and signs of inflammation have resolved.

Fever that persists > 72 hours despite antibiotic therapy suggests

  • A nonbacterial cause

  • Infection with a resistant species

  • Superinfection with a 2nd bacterial species

  • Inadequate serum or tissue levels of the antibiotics

  • Localized infection, such as an abscess

Neutropenic patients with persistent fever are reassessed every 2 to 4 days with physical examination, cultures, and a chest x-ray. If the patient is well except for the presence of fever, the initial antibiotic regimen can be continued, and drug-induced fever should be considered. If the patient is deteriorating, alteration of the antimicrobial regimen is considered (1 Treatment references Neutropenia is a reduction in the blood neutrophil count. If it is severe, the risk and severity of bacterial and fungal infections increase. Focal symptoms of infection may be muted, but fever... read more ).

Fungal infections Overview of Fungal Infections Fungi are eukaryotic organisms that exist as yeast, molds, or both forms. Yeasts consist of solitary cells that reproduce by budding. Molds occur in filaments, also known as hyphae, which extend... read more are the most likely cause of persistent fevers and deterioration. Antifungal therapy is added empirically if unexplained fever persists after 3 to 4 days of broad-spectrum antibiotic therapy. Selection of the specific antifungal drug (eg, fluconazole, caspofungin, voriconazole, posaconazole) depends on the type of risk (eg, duration and severity of neutropenia, past history of fungal infection, persistent fever despite use of narrower spectrum antifungal drug) and should be guided by an infectious disease specialist.

If fever persists after 3 weeks of empiric therapy (including 2 weeks of antifungal therapy) and the neutropenia has resolved, then stopping all antimicrobials can be considered and the cause of fever reevaluated.

For afebrile patients with neutropenia, antibiotic prophylaxis can be considered although alterations in the bacterial microbiome may slow bone marrow recovery. Treatment with fluoroquinolones (levofloxacin, ciprofloxacin) is used in some centers for patients who receive chemotherapy regimens that commonly result in neutrophils ≤ 100/mcL (≤ 0.1 × 109/L) for > 7 days. Prophylaxis is usually started by the treating oncologist. Antibiotics are continued until the neutrophil count increases to > 1500/mcL (> 1.5 × 109/L). Also, antifungal therapy can be given for afebrile patients with neutropenia who are at higher risk of fungal infection (eg, after hematopoietic stem cell transplantation Hematopoietic Stem Cell Transplantation Hematopoietic stem cell (HSC) transplantation is a rapidly evolving technique that offers a potential cure for hematologic cancers ( leukemias, lymphomas, myeloma) and other hematologic disorders... read more or intensive chemotherapy for acute myeloid leukemia Acute Myeloid Leukemia (AML) In acute myeloid leukemia (AML), malignant transformation and uncontrolled proliferation of an abnormally differentiated, long-lived myeloid progenitor cell results in high circulating numbers... read more Acute Myeloid Leukemia (AML) or who have a myelodysplastic disorder Myelodysplastic Syndrome (MDS) The myelodysplastic syndrome (MDS) is group of clonal hematopoietic stem cell disorders typified by peripheral cytopenia, dysplastic hematopoietic progenitors, a hypercellular or hypocellular... read more or a history of prior fungal infections). Selection of the specific antifungal drug should be guided by an infectious disease specialist. Antibiotic and antifungal prophylaxis is not routinely recommended for afebrile patients with neutropenia and no risk factors who are anticipated to remain neutropenic for < 7 days on the basis of their specific chemotherapy regimen.

Myeloid growth factors (ie, granulocyte colony-stimulating factor [G-CSF]) are widely used to increase the neutrophil count and to prevent infections in patients after hematopoietic stem cell transplantation or intensive cancer chemotherapy. If the risk of febrile neutropenia is 30% (as assessed by neutrophil count < 500 mcL [< 0.5 × 109/L], presence of infection during a previous cycle of chemotherapy, associated comorbid disease, or age > 75), growth factors are indicated (2 Treatment references Neutropenia is a reduction in the blood neutrophil count. If it is severe, the risk and severity of bacterial and fungal infections increase. Focal symptoms of infection may be muted, but fever... read more ). In general, most clinical benefit occurs when the growth factor is administered beginning about 24 hours after completion of chemotherapy. Patients with neutropenia caused by an idiosyncratic drug reaction may also benefit from G-CSF, particularly if a delayed recovery is anticipated. The usual dose for G-CSF (filgrastim) is 5 mcg/kg subcutaneously once a day, and the dose for pegylated G-CSF (pegfilgrastim) is 6 mg subcutaneously once per chemotherapy cycle.

Glucocorticoids, anabolic steroids, and vitamins do not stimulate neutrophil production and are generally not helpful to patients with neutropenia. If acute neutropenia is suspected to be caused by a drug or a toxin, all potential etiologic agents are stopped. If neutropenia develops during treatment with an antibiotic known to induce low counts (eg, chloramphenicol), then switching to an alternative antibiotic is recommended.

Saline or hydrogen peroxide gargles every few hours, liquid oral rinses (containing viscous lidocaine, diphenhydramine, and liquid antacid), anesthetic lozenges (benzocaine 15 mg every 3 or 4 hours), or chlorhexidine mouth rinses (1% solution) twice a day or 3 times a day may relieve the discomfort of stomatitis with oropharyngeal ulcerations.

Oral or esophageal candidiasis is treated with nystatin (400,000 to 600,000 units oral rinse 4 times a day; swallowed if esophagitis is present), clotrimazole troche (10 mg slowly dissolved in the mouth 5 times a day), or systemic antifungal drugs (eg, fluconazole).

A semisolid or liquid diet may be necessary during acute stomatitis or esophagitis, and topical analgesics (eg,viscous lidocaine) may be needed to minimize discomfort.

Chronic neutropenia

Neutrophil production and deployment in congenital neutropenia Neutropenia caused by intrinsic defects in myeloid cells or their precursors , cyclic neutropenia Neutropenia caused by intrinsic defects in myeloid cells or their precursors , and idiopathic neutropenia Neutropenia caused by intrinsic defects in myeloid cells or their precursors is usually increased with administration of G-CSF 1 to 10 mcg/kg subcutaneously once a day, beginning with a low dose and increasing to maintain a level of about 1000/mcL (1 × 109/L)(3). Effectiveness is maintained with daily or intermittent G-CSF for months or years.

Long-term G-CSF has also been used in other patients with mild chronic neutropenia (including those with myelodysplasia, HIV infection, autoimmune disorders). Clinical benefits of treatment with G-CSF are less clear, especially for patients who do not have severe neutropenia. For patients with autoimmune disorders such as some patients who have the LGL syndrome or who have had an organ transplant, cyclosporine can also be beneficial.

In the past, splenectomy was used to increase the neutrophil count in patients with splenomegaly and splenic sequestration of neutrophils (eg, Felty syndrome); however, because growth factors and other newer therapies are often effective, splenectomy should be avoided. Splenectomy can be considered for patients with persistent painful splenomegaly or with severe neutropenia (ie, < 500/mcL [< 0.5 × 109/L]) and serious problems with infections in whom other treatments have failed. Patients should be vaccinated against infections caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae before splenectomy because splenectomy predisposes patients to infection by encapsulated organisms.

Treatment references

  • 1. Pizzo PA: Management of patients with fever and neutropenia through the arc of time: A narrative review. Ann Intern Med 170(6):389-397, 2019. doi: 10.7326/M18-3192

  • 2. Becker PS, Griffiths EA, Alwan LM, et al: NCCN guidelines insights: Hematopoietic growth factors, version 1.2020. J Natl Compr Canc Netw 18(1):12-22, 2020. doi: 10.6004/jnccn.2020.0002

  • 3. Dale DC, Bolyard AA, Shannon JA, et al: Outcomes for patients with severe chronic neutropenia treated with granulocyte colony-stimulating factor. Blood Adv 6(13):3861-3869, 2022. doi: 10.1182/bloodadvances.2021005684

Key Points

  • Neutropenia predisposes to bacterial and fungal infections.

  • The risk of infection is proportional to the severity of neutropenia; patients with neutrophil counts < 500/mcL (< 0.5 × 109/L) are at greatest risk.

  • Because the inflammatory response is limited, clinical findings may be muted, although fever is usually present.

  • Febrile neutropenic patients are treated empirically with broad-spectrum antibiotics pending definitive identification of infection.

  • Antibiotic prophylaxis may be indicated as a short-term strategy in high-risk patients.

Drugs Mentioned In This Article

Drug Name Select Trade
Dilantin, Dilantin Infatabs, Dilantin-125, Phenytek
Luminal, Sezaby
Northyx, Tapazole
No brand name available
Clozaril, Fazaclo, Versacloz
No brand name available
FIRVANQ, Vancocin, Vancocin Powder, VANCOSOL
Iquix, Levaquin, Levaquin Leva-Pak, Quixin
Cetraxal , Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR
Neupogen, Nivestym, Releuko, Zarxio
Fulphila, Fylnetra, Neulasta, Nyvepria, Stimufend, UDENYCA, Ziextenzo
AK-Chlor, Chloromycetin, Chloroptic, Chloroptic S.O.P., Ocu-Chlor
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Ela-Max, GEN7T, Glydo, Gold Bond, LidaMantle, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , Lidomar , Lidomark, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
Aid to Sleep, Alka-Seltzer Plus Allergy, Aller-G-Time , Altaryl, Banophen , Benadryl, Benadryl Allergy, Benadryl Allergy Children's , Benadryl Allergy Dye Free, Benadryl Allergy Kapgel, Benadryl Allergy Quick Dissolve, Benadryl Allergy Ultratab, Benadryl Children's Allergy, Benadryl Children's Allergy Fastmelt, Benadryl Children's Perfect Measure, Benadryl Itch Stopping, Ben-Tann , Compoz Nighttime Sleep Aid, Diphedryl , DIPHEN, Diphen AF , Diphenhist, DiphenMax , Dytan, ElixSure Allergy, Genahist , Geri-Dryl, Hydramine, Itch Relief , M-Dryl, Nighttime Sleep Aid, Nytol, PediaCare Children's Allergy, PediaCare Nighttime Cough, PediaClear Children's Cough, PHARBEDRYL, Q-Dryl, Quenalin , Siladryl Allergy, Silphen , Simply Sleep , Sleep Tabs, Sleepinal, Sominex, Sominex Maximum Strength, Theraflu Multi-Symptom Strip, Triaminic Allergy Thin Strip, Triaminic Cough and Runny Nose Strip, Tusstat, Unisom, Uni-Tann, Valu-Dryl , Vanamine PD, Vicks Qlearquil Nighttime Allergy Relief, Vicks ZzzQuil Nightime Sleep-Aid
Advocate Pain Relief Stick, Americaine, Anbesol, Anbesol Baby , Anbesol Jr , Banadyne-3, Benzodent, Benz-O-Sthetic, Boil-Ease, Cepacol Sensations, Chloraseptic, Comfort Caine , Dry Socket Remedy, Freez Eez, Little Remedies for Teethers, Monistat Care, Orabase, OraCoat CankerMelts, Orajel, Orajel Baby, Orajel Denture Plus, Orajel Maximum Strength, Orajel P.M., Orajel Protective, Orajel Severe Pain, Orajel Swabs, Orajel Ultra, Oral Pain Relief , Oticaine , Otocain, Outgro, Pinnacaine, Pro-Caine, RE Benzotic, Topex, Topicale Xtra, Zilactin-B
Betasept, Chlorostat, Hibiclens, Oro Clense , Peridex, Periogard, PerioRx , Perisol
Bio-Statin , Mycostatin, Nyamyc, Nyata, Nystex, Nystop, Pedi-Dri
Alevazol , Antifungal, Anti-Fungal, Cruex, Desenex, Fungoid, Gyne-Lotrimin, Lotrimin, Lotrimin AF, Lotrimin AF Ringworm, Micotrin AC, Mycelex, Mycelex Troche, Mycozyl AC
Cequa, Gengraf , Neoral, Restasis, Sandimmune, SangCya, Verkazia
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