A meta-analysis of controlled studies comparing the association between clozapine and other antipsychotic medications and the development of neutropenia

Myles, Hannah; Xia, Shelley; Large, Matthew; Bird, Robert; Galletly, Cherrie; Kisely, Steve; Siskind, Dan

doi:10.1177/0004867419833166

Cited by 62 publications

(41 citation statements)

References 43 publications

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“…If re-challenge fails, continuing CZP is hazardous. Data are somewhat conflicting about the incidence of neutropenia due to other antipsychotic drugs: Stubner et al [19] found a significantly higher incidence of neutropenia with CZP and also perazine, compared with haloperidol, risperidone, and promethazine; conversely, Myles et al [47] asserted that CZP does not have a stronger association with neutropenia than other antipsychotic drugs. Our clinical experience, supported by literature search, suggests that severe neutropenia is exceedingly rare with Haloperidol and Amisulpride, and virtually non-existent with Aripiprazole.…”

Section: Re-challenge With Clozapinementioning

confidence: 99%

Clozapine-induced agranulocytosis

Mijović

MacCabe

2020

Ann Hematol

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Wider use of clozapine, one of the most effective antipshychotic drugs, is precluded by its propensity to cause agranulocytosis. Currently, clozapine is used for treatment-resistant schizophrenia, with mandatory blood count monitoring for the duration of treatment. Agranulocytosis occurs in up to 0.8% of patients and presents a significant medical challenge, despite decreasing mortality rates. In this paper, we review the epidemiology of clozapine-induced agranulocytosis (CLIA), advances in identifying genetic risk factors, and the preventive measures to reduce the risk of CLIA. We discuss the pathogenesis of CLIA, which, despite receiving considerable scientific attention, has not been fully elucidated. Finally, we address the clinical management and suggest the approach to clozapine re-challenge in patients with a previous episode of neutropenia. With a significant proportion of clozapine recipients in Western hemisphere being Black, we comment on the importance of recognizing benign ethnic neutropenia as a potential impediment to clozapine administration. This review aims to aid haematologists and psychiatrists to jointly manage neutropenia and agranulocytosis caused by clozapine.

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Section: Re-challenge With Clozapinementioning

confidence: 99%

Clozapine-induced agranulocytosis

Mijović

MacCabe

2020

Ann Hematol

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“…This mechanism is said to be the reason that the rates of blood dyscrasia are lower for quetiapine than that of clozapine, even though they have a similar chemical structure. However, in a meta-analysis, it was found that clozapine has no stronger association with neutropenia than other antipsychotic medications [13]. Rather, this may be a class-related effect.…”

Section: Discussionmentioning

confidence: 96%

Low-Dose Quetiapine Causing Agranulocytosis and Leucopenia in a Patient with Benign Neutropenia: A Case Report

Fryer

Billings

2020

Cureus

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Low white blood cell (WBC) counts and agranulocytosis are a relatively rare side effect of atypical antipsychotic treatment. Often, quetiapine is used as an adjunctive medication to help with sleep and mood in some patients. Many times, it is prescribed at lower doses when targeting this mechanism of action, especially when used in combination with antidepressants. The following case highlights the importance of understanding the potential risks in prescribing quetiapine in patients who have underlying genetic susceptibility towards low white blood cell counts.

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“…Bei Auftreten einer Agranulozytose wird das sofortige Absetzen und die Einleitung einer internistischen Therapie mit G-CSF empfohlen. Neuere Studien könnten darauf hinweisen, dass Clozapin im Vergleich zu anderen Antipsychotika kein höheres Risiko einer Agranulozytose aufweist [11,12]. Die Pathogenese beruht am ehesten auf autoimmunen Mechanismen und nicht auf einer toxischen Wirkung [13].…”

Section: Introductionunclassified

Antipsychotika im klinischen Einsatz

Augustin

2020

Klinikarzt

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ZUSAMMENFASSUNGKlinisch tätige Ärztinnen und Ärzte begegnen häufig Patienten, die bereits mit Antipsychotika behandelt werden oder die Erkrankungen wie beispielsweise ein Delir aufweisen, bei denen eine Behandlung mit Antipsychotika erwogen werden kann. Der Artikel gibt einen Überblick über Indikationen, unerwünschte Wirkungen und potenzielle Wechselwirkungen beim Einsatz von Antipsychotika. Besonderes Augenmerk wird auf internistisch relevante unerwünschte Wirkungen gelegt wie thromboembolische Ereignisse, Pneumonie, Agranulozytose und metabolisches Syndrom. Zudem werden bekannte Wechselwirkungen zwischen Antipsychotika und anderen Medikamenten erläutert, die für den klinischen Alltag besondere Relevanz aufweisen. In bestimmten Situationen erfordern diese pharmakokinetischen Wechselwirkungen eine Änderung der Dosis oder den Einsatz von Therapeutischem Drug Monitoring (TDM) zur Bestimmung des Medikamentenspiegels, um die individuell optimale Behandlung zu gewährleisten.

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A meta-analysis of controlled studies comparing the association between clozapine and other antipsychotic medications and the development of neutropenia

Cited by 62 publications

References 43 publications

Clozapine-induced agranulocytosis

Clozapine-induced agranulocytosis

Low-Dose Quetiapine Causing Agranulocytosis and Leucopenia in a Patient with Benign Neutropenia: A Case Report

Antipsychotika im klinischen Einsatz

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