Clozapine-induced neutropenia reversed by lithium

Yadav, Devender; Burton, Simon C.; Sehgal, Chandan

doi:10.1002/pnp.427

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…For patients with stable but marginally adequate neutrophil counts, some clinicians use lithium to raise granulocyte counts above threshold levels to avoid increased monitoring requirements. The mechanism by which lithium increases granulocyte counts is unknown.…”

Section: Specific Adverse Effectsmentioning

confidence: 99%

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Management of common adverse effects of antipsychotic medications

2018

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The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.

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Section: Specific Adverse Effectsmentioning

confidence: 99%

“…Dose reduction is not an effective approach to clozapine‐associated neutropenia. Discontinuation of clozapine is the definitive solution to clozapine‐induced neutropenia.…”

Section: Specific Adverse Effectsmentioning

confidence: 99%

Management of common adverse effects of antipsychotic medications

2018

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“…The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/ph15070817/s1, Table S1A: Case Reports referring to adverse effects of clozapine in relation to drug levels; Tables S1B-S7: Additional data from all included studies (cited in the main manuscript). References [90,[102][103][104][105][106][107][108][109][110][111][112][113] are cited in the supplementary materials.…”

Section: Supplementary Materialsmentioning

confidence: 99%

Adverse Drug Reactions in Relation to Clozapine Plasma Levels: A Systematic Review

et al. 2022

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Clozapine is the gold standard for treatment-resistant schizophrenia. Serious and even life-threatening adverse effects, mostly granulocytopenia, myocarditis, and constipation, are of great clinical concern and constitute a barrier to prescribing clozapine, thus depriving many eligible patients of a lifesaving treatment option. Interestingly, clozapine presents variable pharmacokinetics affected by numerous parameters, leading to significant inter- and intra-individual variation. Therefore, therapeutic drug monitoring of plasma clozapine levels confers a significant benefit in everyday clinical practice by increasing the confidence of the prescribing doctor to the drug and the adherence of the patient to the treatment, mainly by ensuring effective treatment and limited dose-related side effects. In the present systematic review, we aimed at identifying how a full range of adverse effects relates to plasma clozapine levels, using the Jadad grading system for assessing the quality of the available clinical evidence. Our findings indicate that EEG slowing, obsessive-compulsive symptoms, heart rate variability, hyperinsulinemia, metabolic syndrome, and constipation correlate to plasma clozapine levels, whereas QTc, myocarditis, sudden death, leucopenia, neutropenia, sialorrhea, are rather unrelated. Rapid dose escalation at the initiation of treatment might contribute to the emergence of myocarditis, or leucopenia. Strategies for managing adverse effects are different in these conditions and are discussed accordingly.

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Clozapine

2016

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Clozapine-induced neutropenia reversed by lithium

Cited by 5 publications

References 5 publications

Management of common adverse effects of antipsychotic medications

Management of common adverse effects of antipsychotic medications

Adverse Drug Reactions in Relation to Clozapine Plasma Levels: A Systematic Review

Clozapine

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