Diurnal variation of neutropenia during clozapine treatment

Porter, R.; Mohamed, Arif

doi:10.1017/s1461145705006061

Cited by 12 publications

(8 citation statements)

References 3 publications

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“…However, there may be a pronounced circadian rhythm in the leucocyte count (Esposito et al, 2006;Porter and Mohamed, 2006). In one such patient the leucocyte results were 2.9-4.2 L À9 in the morning and 3.6-7.1 L À9 in the afternoon, with granulocytes 0.8-1.4 L À9 and 2.9-5.5 L À9 , respectively (Ahokas and Elonen, 1999).…”

Section: Clozapine and Neutropeniamentioning

confidence: 97%

Haematological toxicity of drugs used in psychiatry

Flanagan

Dunk

2007

Hum. Psychopharmacol. Clin. Exp.

194

154

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Section: Clozapine and Neutropeniamentioning

confidence: 97%

Haematological toxicity of drugs used in psychiatry

Flanagan

Dunk

2007

Hum. Psychopharmacol. Clin. Exp.

194

154

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“…This supports the hypothesis that younger patients treated with clozapine may be more susceptible to neutropenia. (Porter and Mohamed, 2006). …”

Section: Discussionmentioning

confidence: 99%

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

Mattai¹,

Fung²,

Bakalar³

et al. 2009

Human Psychopharmacology

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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.

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“…Few recent reports have described similar cases and have termed this constellation ''morning pseudoneutropenia under clozapine'' (Ahokas and Elonen 1999;Esposito et al 2003;Esposito et al 2004;Porter and Mohamed 2006). It would be highly relevant to reliably discern such benign cases, where clozapine can be continued despite neutropenia, from cases of neutropenia that will progress to agranulocytosis.…”

Section: Case Reportmentioning

confidence: 99%

“…Neutropenia can be an early sign of incipient agranulocytosis. There are, however, some reports on patients, in whom clozapine therapy was continued because of the severity of psychotic symptoms in spite of reduced neutrophil counts with no subsequent development of agranulocytosis (Esposito et al 2004;Porter and Mohamed 2006).…”

mentioning

confidence: 99%