Late-Onset Neutropenia in Long-Term Clozapine Use and Its Management Utilizing Prophylactic G-CSF

O'Neill, Eimear; Carolan, Deirdre; Kennedy, S.; Barry, Sandra

doi:10.1155/2021/6640681

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…One case was also reported in two different articles and was therefore only included once in this review ( Meyer et al, 2015 ; Spencer et al, 2012 ). As detailed in Table 1 , 27 articles were case reports or non-consecutive series (total n = 38 cases) ( Broughton et al, 2012 ; Comacchio et al, 2016 ; Conus et al, 2001 ; Elmore et al, 2016 ; Fabre-Bernal et al, 2019 ; Foster et al, 2017 ; Freeman et al, 2016 ; Friedman et al, 2017 ; Gopalakrishnan et al, 2013 ; Gugger and Caley, 2007 ; Hagg et al, 2003 ; Hazewinkel et al, 2013 ; Huguet et al, 2013 ; Joffe et al, 2009 ; Karst and Lister, 2018 ; Khan et al, 2013 ; Majczenko and Stewart, 2008 ; Martina et al, 2019 ; Mathewson and Lindenmayer, 2007 ; Morrow et al, 2020 ; O’Neill et al, 2021 ; Rajagopal et al, 2007 ; Ruiz-Doblado et al, 2020 ; Sengupta and Harvey, 2010 ; Shuman et al, 2021 ; Spencer et al, 2012 ; Sperner-Unterweger et al, 1998 ), while there were only 2 consecutive case series ( n = 15 cases) ( Béchard et al, 2021 ; Silva et al, 2021 ) and 1 retrospective cohort study ( n = 6 cases) ( Meyer et al, 2015 ), for a total of 59 individual cases.…”

Section: Resultsmentioning

confidence: 99%

Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review

et al. 2023

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Objectives: Rechallenge/continuation of clozapine in association with colony-stimulating factors (CSFs) following neutropenia/agranulocytosis has been reported, but many questions remain unanswered about efficacy and safety. This systematic review aims to assess the efficacy and safety of rechallenging/continuing clozapine in patients following neutropenia/agranulocytosis using CSFs. Methods: MEDLINE, Embase, PsycInfo, and Web of Science databases were searched from inception date to July 31, 2022. Articles screening and data extraction were realized independently by two reviewers, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 systematic review guidance. Included articles had to report on at least one case where clozapine was rechallenged/continued using CSFs despite previous neutropenia/agranulocytosis. Results: Eight hundred forty articles were retrieved; 34 articles met the inclusion criteria, totaling 59 individual cases. Clozapine was successfully rechallenged/continued in 76% of patients for an average follow-up period of 1.9 years. There was a trend toward better efficacy reported in case reports/series, compared with consecutive case series (overall success rates of 84% and 60%, respectively, p-value = 0.065). Two administration strategies were identified, “as-needed” and prophylactic, both yielding similar success rates (81% and 80%, respectively). Only mild and transient adverse events were documented. Conclusions: Although limited by the relatively small number of published cases, factors such as time of onset to first neutropenia and severity of the episode did not seem to impact the outcome of a subsequent clozapine rechallenge using CSFs. While the efficacy of this strategy remains to be further adequately evaluated in more rigorous study designs, its long-term innocuity warrants considering its use more proactively in the management of clozapine hematological adverse events as to maintain this treatment for as many individuals as possible.

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Section: Resultsmentioning

confidence: 99%

Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review

et al. 2023

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Clozapine/paliperidone/zopiclone

2021

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Psychotropic medications around perioperative period: How to go about?

Grover

Naskar

2023

JSPF

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Background: Medical comorbidities are frequent in patients suffering from psychiatric disorders. Many of these patients would need emergency or elective surgeries in their lifetime. The perioperative period is a unique and critical phase, and thoughtful, informed management can prevent various medical misadventures in this period, thus improving the postoperative outcomes. Aim: This article attempts to provide an overview of the use of psychopharmacological agents during the perioperative period, the current recommendations about continuing or discontinuing various psychotropics in the perioperative period, and how to restart medications in the postsurgical period. Material and Methods: For this narrative review, literature search was done on PubMed and Google Scholar and relevant articles were identified and included. Results: For elective surgery, the psychiatrist should review the available investigation, severity of the physical illness, physical health status of the patient as per the American Society of Anaesthesiology (ASA) category, severity and stability of psychiatric disorder, comorbid substance use, and the ongoing psychotropics and their interactions with ongoing medications. In patients with ASA categories I and II, psychotropic medications can be continued. For patients with ASA categories V and VI, preferably psychotropics should be stopped. For patients belonging to ASA categories III and IV, antipsychotics except for clozapine can be continued; however, if feasible antidepressants and lithium should be stopped. For elective surgery, clozapine needs to be stopped 12 h before surgery, lithium 48–72 h before surgery, antidepressants to be tapered about 7–10 days before surgery, and monoamine oxidase inhibitors to be tapered and stopped 14 days before surgery. Other antipsychotics, mood stabilizers, and benzodiazepines can be continued till the day of surgery. When there is lack of time due to emergency surgery then a proper discussion with the primary team and the anesthetist need to be done about the possible risks. Conclusion: The psychiatrists handling patients in the perioperative period should have an idea about how psychotropics interact with different anesthetic agents and ensure that the anesthesiologist and the surgeon are made aware of the possible complications that might occur during the surgical and anesthetic procedure due to the concurrent use of specific psychotropics.

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Late-Onset Neutropenia in Long-Term Clozapine Use and Its Management Utilizing Prophylactic G-CSF

Cited by 3 publications

References 14 publications

Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review

Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review

Clozapine/paliperidone/zopiclone

Psychotropic medications around perioperative period: How to go about?

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