Clozapine and agranulocytosis: re-assessing the risks

Drew, Leslie R.H.

doi:10.1177/1039856213491990

Cited by 21 publications

(16 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although clozapine is uniquely efficacious in treating treatment-resistant schizophrenia, it requires monitoring of white blood cell counts (WBC) due to a higher risk of potentially life-threatening agranulocytosis(1%) 31. Clozapine is also associated with a higher risk of seizure32 and myocarditis 33.…”

Section: Discussionmentioning

confidence: 99%

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia

Alosaimi

Alruwais

Alanazi

et al. 2016

NSJ

View full text Add to dashboard Cite

Objective:To explore the possible causes behind adults seeking psychotropic medications without a prescription; identify the most commonly used psychotropic medications without a prescription; and determine the prevalence of depression and anxiety disorders among adults who used psychotropic medications without a prescription in Riyadh, Kingdom of Saudi Arabia.Methods:A cross-sectional study was conducted from November 2014 to August 2015. A convenience sample was taken by distributing a self-administered questionnaire among participants who had obtained psychotropic medications without a prescription from retail pharmacies during the 4 weeks prior to study intake in Riyadh, Kingdom of Saudi Arabia. In addition to the study questionnaire, the 9-item Patient Health Questionnaire was used to screen for major depressive disorder, and the 7-item Generalized Anxiety Disorder Scale was used to screen for general anxiety disorders.Results:Of the 302 subjects, 42.4% attributed their use of psychotropic medications without a prescription to the non-seriousness of their symptoms and 28.5% to the high cost of psychiatric services. Escitalopram was the most commonly used medication (31.8%), and 3 atypical antipsychotics were used by more than one-fifth of the study participants. The prevalence for major depressive disorder was 46.0% and 41.7% for generalized anxiety disorder.Conclusions:Most of the participants were able to easily obtain psychotropic medications without a prescription. We recommend implementing strong policies to prevent retail pharmacies from dispensing psychotropic medications without a prescription.

show abstract

Section: Discussionmentioning

confidence: 99%

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia

Alosaimi

Alruwais

Alanazi

et al. 2016

NSJ

View full text Add to dashboard Cite

show abstract

“…However, they estimated that without current monitoring, approximately 28 cases of agranulocytosis would occur per year. 13 Unfortunately, the apparent inflexibility of the FDA guidelines has created a significant impediment to the broader use of clozapine, especially in patients of African and Middle Eastern descent, who may manifest “Benign Ethnic Neutropenia” (BEN). This condition may be explained by a genetic polymorphism which affects the expression of the Duffy antigen on red blood cells.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Safety of Clozapine Use in Patients With Benign Neutropenia

Richardson

Davis

Vyas

et al. 2016

J. Clin. Psychiatry

View full text Add to dashboard Cite

Objective Determine if clozapine can be safely utilized in a population of psychiatric patients with current or a history of benign neutropenia. Method A single-center, retrospective chart review was conducted in an inpatient psychiatric hospital. Patients included had benign neutropenia prior to receiving clozapine and received clozapine using modified monitoring guidelines. All available laboratory values for absolute neutrophil count (ANC) before clozapine initiation and during treatment were evaluated. The primary endpoint was the difference in ANC after initiation of clozapine compared to before clozapine treatment. Results A total of 26 patients were reviewed. Mean age was 34 years at clozapine initiation. The majority were African-American (73%), with more males than females (73% vs. 27%). The mean lowest ANC value was not significantly different after clozapine initiation compared to before (1.5 and 1.4×103 cells/mm3, respectively; p=0.22). There were no cases of agranulocytosis (ANC <0.5 ×103 cells/mm3) and no patients were discontinued for falling below limits set by modified guidelines. There were fewer occurrences of mild neutropenia (ANC <2.0×103 cells/mm3) after clozapine initiation than before (16% and 31.4%, respectively; p<0.001). There were also fewer occurrences of moderate neutropenia (ANC <1.5×103 cells/mm3) with 2.1% after clozapine and 13.3% before (p<0.001). Occurrence of ANC <1.0×103 cells/mm3 did not differ (0.4% before, 0.3% after, p=0.79). Conclusion Twenty-six patients with benign neutropenia were safely treated with clozapine. Their pre-clozapine neutropenia did not predict increased risk for agranulocytosis with clozapine. Patients had significantly fewer episodes of mild and moderate neutropenia after receiving clozapine compared to before.

show abstract

“…Clozapine has potentially fatal adverse effects such as myocarditis, constipation, and agranulocytosis . Yet, no reports in this analysis were reported as severe or leading to death.…”

Section: Discussionmentioning

confidence: 67%

A mixed methods analysis of clozapine errors reported to the National Reporting and Learning System

Dabba

Elswood

Ahmed³

et al. 2019

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

Purpose To review and analyse medication errors related to clozapine, an atypical antipsychotic, that were reported to the National Reporting and Learning System (NRLS). Methods Following extraction of one year of clozapine related errors from the NRLS, a qualitative analysis (thematic analysis and re‐classification) and quantitative analysis was performed. An incident was considered a clozapine error if there was a failure in its medication process (i.e. an error in the prescribing, dispensing, preparing, administering, monitoring or advising of clozapine). Results “Issues with stock/supply/ordering” was the most common theme derived from the qualitative thematic analysis (n = 338), followed by wrong dose/strength/frequency (n = 221) and medication omissions (n = 202). Most errors occurred in the “administration/supply” medication stage. Over half of reported clozapine incidents involved people 26 to 55 years old (n = 830) and 82% of errors were reported by mental health services (n = 1270). Only 1.5% of reports were classed as moderate/severe harm. Conclusion Issues with availability, stock, and supply were found to be the most common causes. This usually entailed a lack of stock to fulfil a patient's dose/supply. Such incidents could potentially be reduced by improved management of the supply process, and liaison between pharmacy and clinical staff. The implementation of emergency drug cupboards at the discretion of an on‐call pharmacist may prove to be a preventative measure for such errors. Despite the potential adverse effects associated with clozapine, very few incidents led to moderate/severe harm. Encouragement of NRLS reporting is recommended for incidents of all degrees of harm.

show abstract

Clozapine and agranulocytosis: re-assessing the risks

Cited by 21 publications

References 4 publications

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia

Evaluation of the Safety of Clozapine Use in Patients With Benign Neutropenia

A mixed methods analysis of clozapine errors reported to the National Reporting and Learning System

Contact Info

Product

Resources

About