Reversible Neutropenia during Treatment with Olanzapine: Three Case Reports

Abstract

Olanzapine is an atypical antipsychotic with a low incidence of extrapyramidal-motoric side effects. Its chemical structure is related to clozapine, which is known to induce neutropenia in up to 3% and agranulocytosis in approximately 1% of patients. It has been discussed controversially whether olanzapine also has a potential to induce neutropenia and agranulocytosis. Up to now, seven case reports of haematopoetic disturbances during olanzapine treatment have been published, including one case of olanzapine-induced agranulocytosis (Naumann et al. 1999), two cases of neutropenia (Steinwachs et al. 1999) and one leucopenia (Meissner et al. 1999). We report three subjects with reversible neutropenia under olanzapine, with rapid normalisation of neutrophil cell counts after discontinuation of olanzapine. In one case neutropenia occurred after administration of a single dose of olanzapine, in another case after 6 weeks of treatment. In both cases, patients had no clinical complications. In the third case, neutropenia appeared after 1.5 years of treatment followed by development of pneumonia. Two cases were recorded within the German drug surveillance project (AMSP); the third case was observed in a randomised, double-blind, multicentre study comparing olanzapine with clozapine.

Haematological toxicity of drugs used in psychiatry

“…However, as the dose of olanzapine is generally much lower weight for weight than that of clozapine, clinical manifestations of this problem are relatively rare (Cordes et al, 2004;Duggal et al, 2004;Stergiou et al, 2005;Stip et al, 2007) despite in vitro assay data suggesting greater myelotoxicity than clozapine [the actual results (IC90, mg L À1 ) were: chlorpromazine (10.02 AE 0.69), olanzapine (13.43 AE 1.23), clozapine (44.71 AE 4.42) and quetiapine (137.24 AE 15.36) (Pessina et al, 2006)]. …”

Leukopenia and thrombocytopenia on adding aripiprazole to phenytoin

“…Besides clozapine, literature review and PubMed search reveals anecdotal reports of blood dyscrasias with other second-generation antipsychotics such as olanzapine, quetiapine, ziprasidone, and risperidone (Duggal and Singh 2005;Cordes et al 2004). A similar search yielded no published reports of this adverse effect with aripiprazole.…”

Antipsikotik kullanımıyla tetiklenen nötropeni olgusunda tedaviye lityum eklenmesi

“…Literatürde, ketiapine (5-7), olanzapine (1,8) ve risperidona (9) bağlı lökopeni olguları bildirilmektedir. Atipik ve sonrasında tipik antipsikotik kullanımıyla klinik tablonun değişmemesi ve nötropeni riskinin hala sürüyor olması nedeniyle tedaviye lityum eklenmiştir.…”

“…Literatürdeki atipik antipsikotiklere bağlı ortaya çıkan nötropeni oranlarına bakıldığında; olanzapin tedavisine bağlı nötropeni gelişme oranı %4.6 olarak bildirilmiş, ancak bu, tedavi kesilmesini gerektiren bir durum olarak belirtilmemiştir (1). Ketiapin dibenzodiazepin grubu bir antipsikotiktir ve nötropeni ve agranülositoz gelişmesi %1.9-4.2 vakada bildirilmiştir (2).…”