Prolongation of Clozapine-Induced Granulocytopenia Associated With Olanzapine

Sw, Flynn; Altman, Siemion; Gw, MacEwan; Ll, Black; Ll, Greenidge; Wg, Honer

doi:10.1097/00004714-199712000-00014

Cited by 35 publications

(16 citation statements)

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“…However, by August 1997, seven cases of alteration in red blood cells, eight of leucopenia, six of granulocytopenia, one eosinophilia, one neutropenia and one case of agranulocytosis were reported in patients treated with olanzapine (Fritze and Bandelow 1998). More-II/8 over, a case study of three patients with clozapine-induced granulocytopenia suggests that recovery from this condition is delayed in patients treated with olanzapine (Flynn et al 1997). Risperidone and sertindole do not reduce neutrophil count (Zimbroff et al 1997;Marder and Meibach 1994).…”

Section: Haematologymentioning

confidence: 99%

Benefit-risk evaluation of olanzapine, risperidone and sertindole in the treatment of schizophrenia

Kasper

Hale

Azorin

et al. 1999

European Archives of Psychiatry and Clinical Neurosciences

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Section: Haematologymentioning

confidence: 99%

Benefit-risk evaluation of olanzapine, risperidone and sertindole in the treatment of schizophrenia

Kasper

Hale

Azorin

et al. 1999

European Archives of Psychiatry and Clinical Neurosciences

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“…The hematological safety of olanzapine was questioned after some cases of granulocytopenia due to clozapine though persisting after a switch to olanzapine were reported [4,15,26]. By now, several cases of olanzapine-induced neutropenia or leukopenia have been reported by AMSP (38) as well as by other authors [6,9,29,31,41,42].…”

Section: Discussionmentioning

confidence: 99%

Blood Dyscrasias Induced by Psychotropic Drugs

2004

Pharmacopsychiatry

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Drugs can cause a variety of blood dyscrasias, e. g., by interfering with hematopoiesis in the bone marrow or damaging mature blood cells by antibodies. Although numerous reports on the risks of adverse hematological effects associated with psychotropic drugs have led to stringent monitoring requirements for some compounds, particularly neuroleptics, it is still difficult to estimate the true prevalence of such risks. Sixteen episodes of thrombocytopenia, 63 of neutropenia, 22 of agranulocytosis, 4 episodes of severe neutro- and thrombocytopenia, and 2 of pancytopenia were documented by the drug safety program in psychiatry AMSP (Arzneimittelsicherheit in der Psychiatrie) in a population of 122,562 patients between 1993 and 2000. All cases were related to the epidemiological data provided for this population and systematically analyzed as regards history of medication, co-medication, and the clinical course. Putative risk rates for the main groups of medications and a number of drugs could be estimated with this database. Most changes in the white blood cell counts, which were rated as probably or definitely drug-induced, were attributed to clozapine (0.18 % of patients exposed), carbamazepine (0.14 %) and perazine (0.09 %). In patients on newer atypical neuroleptics, we documented neutropenia assumed to be probably or definitely drug-related in five patients during treatment with olanzapine and in one case with risperidone. In all five olanzapine-related cases, the drugs were the sole cause of the adverse drug reactions. All surveyed patients who received clozapine showed no difference in age and gender distribution from those who developed hematological changes. Incidences of hematological changes for antidepressants were much lower (about 0.01 %). Although the methodological accuracy of these findings has to be critically discussed these data could be of considerable clinical relevance and should be helpful in making clinical treatment decisions.

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“…Klozapin tedavisine haloperidol, pimozid, loksapin, olanzapin ve ketiyapin eklenmesinin klinik etkinliğini gösteren olgu bildirimleri ve küçük örneklemli açık çalışmalar da mevcuttur (Mowerman ve Siris 1996, Flynn ve ark. 1997, Friedman ve ark.…”

Section: Bulgular Klozapin Tedavisinin Antipsikotiklerle Güçlendirilmesiunclassified

Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine Treatment

Vayısoğlu¹,

Yağcıoğlu²

2014

Turkish Journal of Psychiatry

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ÖZETKlozapin tedavisi kullanan şizofreni hastalarının önemli bir oranı tedaviye kısmi yanıt vermektedir. Bu grup hastalarda klozapin tedavisine değişik psikotropların eklendiği güçlendirme yöntemleri ile ilgili bulgular çelişkilidir. Bu derlemede klozapin tedavisine dirençli şizofre-ni hastalarında güçlendirme ajanlarının etkinliği ve güvenliği ile ilgili yazın verileri gözden geçirilmiştir. Klozapini tedaviye dirençli şizofreni hastalarında güçlendirmek için kullanılan ek tedaviler antipsikotikler, antidepresanlar, duygudurum düzenleyicileri, diğer farmakolojik ajanlar (örneğin omega 3 yağ asitleri ve glutamaterjik tedaviler) ve elektrokonvulzif tedavi (EKT) olarak gruplanmıştır. Klozapinin tedaviye dirençli şizofreni hastalarında güçlendirilmesi ile ilgili en çok kontrollü çalışma-nın lamotrijin ve risperidon ile yapılmış olduğu görülmektedir. Ancak, meta analizler iki ajanın da klozapine eklenmesinin yararını desteklememektedir. Klozapinin amisülprid, aripiprazol, mirtazapin, omega 3 yağ asitleri ve EKT ile güçlendirilmesinin olumlu sonuç verdiğini destekleyen çalışmalar olsa da, delil/kanıt yeterli değildir ve ek araştırma-lara gereksinim vardır. Güncel çalışmalarda başlıca kısıtlılık, örneklem küçüklüğü, klozapine direnç tanımının sabit olmaması ve tanımlanmış sonlanım ölçütleri ile çalışma desenlerinin farklılık göstermesidir. Sonuç olarak, klozapin tedavisine dirençli şizofreni hastalarında tedavinin güç-lendirilmesi yöntemlerinin başarısı ile ilgili henüz yeterli kanıt yoktur.Anahtar Sözcükler: Şizofreni, klozapin, tedaviye direnç, güçlendirme tedavisi SUMMARY Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine TreatmentA significant proportion of patients with schizophrenia receiving clozapine remain with partial response. In this group of patients findings regarding addition of various psychotropics to ongoing clozapine treatment for augmentation are controversial. In this review, literature regarding the efficacy and safety of adjunctive agents in clozapine resistant schizophrenic patients is examined. Augmentation agents added to clozapine in treatment resistant schizophrenic patients consist of antipsychotics, antidepressants, mood stabilizers, other agents (eg. omega 3 fatty acids and glutamatergic agents) and electroconvulsive therapy (ECT) in this review. The number of controlled studies evaluating augmentation of clozapine in schizophrenia patients are highest for risperidone and lamotrigine add on treatments. However, the results of recent meta-analyses studies do not support any benefit of either agent as adjunct to clozapine treatment. Some evidence regarding the success of clozapine augmentation with amisulpride, aripiprazole, mirtazapine, omega 3 fatty acids and ECT have been obtained which needs further clinical investigation. Current findings from relevant clinical studies point that theses studies have limitations of small sample size, variable definitions of clozapine resistance, heterogenity of outcome measures and methodological designs and th...

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Prolongation of Clozapine-Induced Granulocytopenia Associated With Olanzapine

Cited by 35 publications

References 4 publications

Benefit-risk evaluation of olanzapine, risperidone and sertindole in the treatment of schizophrenia

Benefit-risk evaluation of olanzapine, risperidone and sertindole in the treatment of schizophrenia

Blood Dyscrasias Induced by Psychotropic Drugs

Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine Treatment

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