Adjunctive use of lithium carbonate for the management of neutropenia in clozapine‐treated children

Abstract

Objective Clozapine, a dibenzodiazepine antipsychotic, is the most effective medication for treatment resistant schizophrenia. However, its use has been limited by the high risk of neutropenia. In children, the rate of neutropenia is higher when compared to adults. We decided to explore the use of lithium to manage neutropenia in childhood-onset schizophrenia (COS) through a systematic audit of COS cases. Methods Medical records were reviewed for patients with childhood-onset schizophrenia (COS) who had been treated with the combination of clozapine and lithium carbonate. Results Seven patients were found to have been treated with both clozapine and lithium. After initiation of lithium, ANC increased significantly in six out of seven subjects by 29% to 106% with a mean of 66%. In addition, six out of seven subjects continued use of both clozapine and lithium for over 2 years (range: 2.0 to 7.2 years) and do not have immediate plans for discontinuation of either medications. Conclusions Our study bolsters support for the use of lithium in the management of neutropenia in children treated with clozapine. Although the coadministration of lithium and clozapine appears effective in the management of neutropenia, it is not without its risks and clinicians must be diligent in their joint use of these medications.

A genetic network model of cellular responses to lithium treatment and cocaine abuse in bipolar disorder

“…perphenazine, thioridazine, asenapine, chlorpromazine, and clozaril) [ 69 ]. Clozaril, known for its potential side effect of neutropenia, is a medication purported to be effective in treatment resistant schizophrenia illness [ 70 ]. The onset of such neutropenia is frequently managed successfully with the stoppage of clozaril treatment and the initiation of lithium treatment.…”

Haematological toxicity of clozapine and some other drugs used in psychiatry

“…Successful use of adjunctive lithium has been reported in children who developed neutropenia when treated with clozapine (Mattai et al ., 2009; Sporn et al ., 2003) or with clozapine in conjunction with aripiprazole (Gagliano and Masi, 2009). However, as in adults lithium does not always raise the neutrophil count.…”

Concomitant Use of Topiramate Inducing Neutropenia in a Schizophrenic Male Stabilized on Clozapine

“…At the time of admission, the patient had not been taking clozapine for two days as the pharmacy refused to refill it. During the hospital course, topiramate was tapered off, the patient was started on olanzapine 10 mg daily, and lithium was started to aid in mood stabilization and to help control WBC/ANC levels by virtue of its ability to potentially cause leukocytosis [ 6 ]. The patient tolerated the transition from clozapine to olanzapine and lithium.…”