Clozapine-induced leukopenia successfully treated with lithium

Kutscher, Eric C; Robbins, Garry P.; Kennedy, W. Klugh; Zebb, Kristi; Stanley, M. W.; Carnahan, Ryan M.

doi:10.2146/ajhp060319

Cited by 31 publications

(15 citation statements)

References 21 publications

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“…Lithium's co-administration with clozapine has been suggested as a means of preventing neutropenia on clozapine rechallenge and has met with some success (16,(29)(30)(31). In our patient, the addition of lithium led to a 2.0×10 3 cells/ml increase in WBC count and a 1600/ml increase in absolute neutrophil count.…”

Section: Discussionmentioning

confidence: 61%

“…To the best of our knowledge, there have been only four case reports of neutropenia or agranulocytosis at 5 or more years of treatment with clozapine (6,7,15,16). The greatest reported risk of developing neutropenia or agranulocytosis with clozapine is during the first 6 months of treatment (5).…”

Section: Discussionmentioning

confidence: 99%

“…There are case reports of adverse neurological effects, including tremors, involuntary movements, and seizures (16,34,36,37), as well as case reports of agranulocytosis (38,39), in patients taking clozapine and lithium. However, the adverse neurological effects reported in most cases were transient and occurred only during initiation of lithium treatment (16,36,40); in other cases, the picture was complicated by polypharmacy and the possible contribution of other medications, including haloperidol (16) and serotonergic agents (40). Similarly, one of the two cases of agranulocytosis reported was complicated by haloperidol, as well as a number of anticonvulsants that themselves carry a risk of blood dyscrasia in that patient's medication regimen (39).…”

Section: Discussionmentioning

confidence: 99%

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Rechallenging With Clozapine Following Neutropenia: Treatment Options for Refractory Schizophrenia

Ghaznavi¹,

Nakic²,

Rao³

et al. 2008

AJP

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Cl ozapine, a second-generation antipsychotic, is the treatment of choice in refractory schizophrenia because of its proven efficacy over typical antipsychotics as well as other atypical antipsychotics (1). However, a major drawback to clozapine therapy is the increased risk of neutropenia and agranulocytosis (2). In patients who develop either of these serious side effects, clozapine is immediately discontinued. Unfortunately, trials of other antipsychotics often prove ineffective, and clinicians find themselves faced with the difficult decision of whether to rechallenge those patients with clozapine (3). Even more concerning for the clinician is the relative absence of any controlled data to suggest treatment options when clozapine cannot be used because of serious side effects, such as neutropenia or agranulocytosis. This case review highlights this particular aspect and provides some useful thinking points for clinicians and patients in this situation.Efforts at rechallenge with clozapine have met with some success (4-9). In a retrospective review of 53 cases of clozapine rechallenge in the United Kingdom and Ireland, 62% of the patients did not develop a blood dyscrasia on rechallenge (8). Of course, clozapine rechallenge is not without its risks. In the same retrospective review, it was found that among the 38% of cases who did develop a blood dyscrasia on rechallenge, in 85% of the cases, the blood dyscrasia occurred more quickly and was more severe than with the initial trial of clozapine. In addition, in 65% of the cases in which patients developed a blood dyscrasia on rechallenge, the blood dyscrasia lasted longer after discontinuation of clozapine following rechallenge than when clozapine was first discontinued. Thus, when deciding whether to rechallenge a patient with clozapine, the clinician must carefully weigh the risks and benefits of a clozapine rechallenge. Here we present a patient with refractory schizophrenia who successfully tolerated a clozapine challenge 2 years after developing clozapine-induced neutropenia and failing to respond to a subsequent clozapine rechallenge. We propose that polypharmacy may have contributed to the initial episode of neutropenia as well as the failed clozapine rechallenge in our patient. We also discuss logical issues in medical decision making before considering clozapine rechallenges in patients.Case Presentation "S.P." was a 55-year-old divorced African American man with a 30-year history of paranoid schizophrenia who was referred to our unit for medication adjustment after a 2-year gradual worsening of psychotic symptoms characterized by thought disturbance and behavioral disorganization. As a result of his worsening symptoms, 3 months before admission, S.P. went from living independently in a supervised care setting to requiring close supervision and help with activities of daily living. Two months before admission, he stopped bathing and washing his clothes and refused to socialize. S.P.'s relationship with his case manager, which had previously been good, ...

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rechallenging With Clozapine Following Neutropenia: Treatment Options for Refractory Schizophrenia

Ghaznavi¹,

Nakic²,

Rao³

et al. 2008

AJP

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“…Only four case reports were found of neutropenia or agranulocytosis at 5 or more years of treatment with clozapine on literature review at Psych Info and MD Consult [3][4][5][6]. The literature review was conducted by using the following keywords: clozapine, leukopenia, neutropenia, agranulocytosis, rechallenge with clozapine, and blood dyscrasia.…”

Section: Discussionmentioning

confidence: 99%

Clozapine-induced late leukopenia

Latif¹,

Malik

Jabbar

et al. 2010

Ir J Med Sci

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A patient with a 28-year history of schizophrenia was treated with a wide range of antipsychotic medications since diagnosis. She had experienced no clinically significant symptomatic relief until she commenced treatment on clozapine. Her psychotic symptoms, self care, and general sense of well-being improved significantly. After 6 years of successful treatment, she developed leukopenia and clozapine was discontinued. The following issues will be discussed in the article: rechallenge with clozapine following leukopenia during previous therapy and the choice of and haematological monitoring needs with other antipsychotic medications after clozapine-induced blood dyscrasia.

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“…Um efeito colateral temido e que limita seu uso é a neutropenia [1][2][3][4][5][6][7][8][9][10][11][12] . O caso relatado é de um paciente com diagnóstico de esquizofrenia grave e refratária que obteve excelente resposta clínica à clozapina acompanhada, porém, de neutropenia progressiva, o que levou à interrupção do tratamento.…”

Section: Introductionunclassified

Use of lithium in the treatment of clozapineinduced neutropenia: a case report

Garcia¹,

Peregrino

França³

2017

Revista Debates Em Psiquiatria

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Iniciada a clozapina, observou-se excelente resposta, porém houve o achado de neutropenia significativa na 11ª semana de uso do medicamento, quando, então, foi decidida sua suspensão. Face à gravidade do caso e boa resposta à clozapina, o carbonato de lítio foi usado como agente estimulador de granulopoiese e, após normalização e estabilização da contagem de neutrófilos, a clozapina foi reinserida ao esquema terapêutico. O paciente obteve boa melhora clínica, alta hospitalar e vem mantendo-se estável desde então. O caso sugere as possibilidades de usar novamente a clozapina em pacientes que tenham apresentado granulocitopenia, caso a associação com o lítio seja possível, e do uso prévio de lítio em pacientes com níveis baixos de leucócitos, mas que sejam candidatos a uso de clozapina.Palavras-chave: Clozapina, lítio, neutropenia. AbstractClozapine is the antipsychotic of choice for the treatment of refractory schizophrenia. Agranulocytosis, however, is a serious side effect that may limit its use. We describe the case of a 25-year old patient, hospitalized, diagnosed with refractory schizophrenia. Clozapine was initiated, with excellent response, but significant neutropenia was observed at 11 weeks of drug use, and clozapine was then discontinued. Given

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Clozapine-induced leukopenia successfully treated with lithium

Cited by 31 publications

References 21 publications

Rechallenging With Clozapine Following Neutropenia: Treatment Options for Refractory Schizophrenia

Rechallenging With Clozapine Following Neutropenia: Treatment Options for Refractory Schizophrenia

Clozapine-induced late leukopenia

Use of lithium in the treatment of clozapineinduced neutropenia: a case report

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