Continuing clozapine treatment with lithium in schizophrenic patients with neutropenia or leukopenia: brief review of literature with case reports

Aydın, Memduha; İlhan, Bilge Çetin; Çalışır, Saliha; Yıldırım, Seda Elçim; Eren, İbrahim

doi:10.1177/2045125315624063

Cited by 27 publications

(23 citation statements)

References 39 publications

(48 reference statements)

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“…Administration of clozapine can cause drug-induced leukopenia and neutropenia, especially in the patient with low WBC or Co-administration with other medicines [45–49]. In this study, platelet and leukocyte count of NS-treated group significantly was lower than ILE-treated group, which reflects the ability of ILE to prevent of clozapine-induced leukopenia and neutropenia.…”

Section: Discussionmentioning

confidence: 57%

Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats

et al. 2019

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Section: Discussionmentioning

confidence: 57%

Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats

et al. 2019

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“…In cases of neutropenia, the co-prescribing of lithium is supported by several reports [2,7]. The evidence regarding the efficacy of lithium for increasing the total leucocyte count is not robust.…”

Section: Resultsmentioning

confidence: 78%

“…Several prior studies also found that neutropenia can occur many years after the start of clozapine treatment. Nongpiur et al [2] reported a case of leucopenia that emerged after 11 years of continuous clozapine monotherapy. Taking these findings into account, it appears that the agranulocytosis occurs the lifelong for clozapine treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Clinicians should monitor a patient for neutropenia during the entire period of clozapine treatment. Although the greatest risk of developing this adverse reaction is during the initial 6-month exposure, clozapine-induced neutropenia may pose a risk after years of exposure [1][2][3]. The current product labeling for clozapine recommends the weekly determination of a patient's total leucocyte count and granulocyte monitoring for the first 6 months of treatment, which may be decreased to biweekly monitoring based on the sudden and late onset of agranulocytosis in our patient in Japan according to the regulation of Clozaril Patient Monitoring Service.…”

Section: Resultsmentioning

confidence: 99%

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Very Late-Onset Neutropenia in a Japanese Schizophrenia Patient Treated with Clozapine

Yoshimura¹,

Takashima²,

Nakamura³

2017

J Clin Case Rep

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We here reported a chronic schizophrenia patient who occurred neutropenia 13 years after starting clozapine. Thus, once clozapine is administered, the lifelong regular monitoring of the patient's total WBC count should be done.Keywords: Clozapine; Neutropenia; Late-onset Case ReportThe patient was a 46-year-old Japanese man who had met the DSM-IV diagnosis of schizophrenia, disorganized-type, for the prior 30 years. He had been on antipsychotic regimens since being diagnosed when he was 16 years old. He had been treated with therapeutic doses of sulpiride, haloperidol, levomepromazine, risperidone, olanzapine, aripiprazole, or lithium on several occasions, after which the treatments were stopped due to inadequate treatment response. After that, clozapine was started during his eighth hospitalization in 33-year-old in which he was brought to the hospital for persistent auditory hallucinations, monologia, persecutory delusion aggressiveness, and psychomotor excitement.After this admission, the clozapine dosage was titrated gradually up to 600 mg/day. The patient's total leucocyte count at baseline was 10,000/mm 3 . After discharge from the hospital, he showed a prominent improvement in his clinical status, with no apparent psychotic symptoms, and he attended a day-care service. During the long follow-up period, his total leucocyte count range was between 5,380 and 11,290/mm 3 with a daily 600 mg clozapine dosage. Twelve years after the start of that clozapine treatment, the patient's total leucocyte count had gradually decreased to 2,255 mm 3 . We therefore added lithium carbonate (600 mg/day) to increase the leucocyte count. However, the total leucocyte count did not recover after the addition of lithium carbonate (2,460 mm 3 , 1,663 mm 3 , 1,584 mm 3 , 1,526 mm 3 ). In 46-year-old (13 years later), the patient's total leucocyte count had gradually declined to 1,330/ mm 3 , and the 600 mg/day clozapine was stopped at the same time. His auditory hallucination, persecutory delusion, irritability, psychomotor excitement were exacerbated after stopping clozapine. Olanzapine (20 mg/day) and levomepromazine (150 mg/day) were re-started; those symptoms were however not ameliorated. Physical symptoms associated with neutropenia including fever, anemia, bleeding, irritability, and hot flashes were not seen. Four weeks after the clozapine was discontinued, the patient's total leucocyte count had recovered to 8,915/mm 3 . Written informed consent to have his case published was obtained from the patient.

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“…A leucopenia é a redução de leucócitos no sangue, podendo comprometer a defesa imunológica do paciente. Podem ser classificados conforme a gravidade em: leucopenia média [células brancas sanguíneas (CBS) com contagem de 35003000/mm3 ou absoluta [contagem de neutrófilo (ACN) de 2000-1500/mm3], leucopenia moderada (CBS 3000-2000/mm3 , ACN 1500-1000/mm3), ou leucopenia grave (CBS contagem < 2000/mm3 , ACN < 1000/mm3 ) (AYDIN et al, 2016). Agranulocitose é caracterizada pela redução de leucócitos granulosos, prejudicando assim as principais barreiras contra infecções, apresenta o ACN ≤ 500/mm3 (BALDA et al, 2015).…”

Section: Fonte: Dados Da Pesquisa (2019)unclassified

Perfil do leucograma em pacientes com esquizofrenia refratária que usam clozapina

Mendes

Lima

Britto

et al. 2020

RSD

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Schizophrenia is a chronic mental illness quite present in Brazilian society, but it does not have the care and attention necessary to make the patient's well-being satisfactory. It has a very complex pharmacodynamics, where without proper care, can cause adverse effects that may harm the health of the patient. Therefore, the objective of this study is to evaluate in the last five years the leukogram profile of patients with refractory schizophrenia who use clozapine assisted in the Specialized Component of Pharmaceutical Care of Piauí, by analyzing data that will be collected through the evaluation of medical records. analyzing and verifying that the leukogram levels of these patients are within the parameters recommended by the literature. They were then checked in the SOFTWARE PRISMA 6.0 program. The results showed that of the analyzed charts, regarding gender, 64% were men and 36% were women. There was an incidence of agranulocytosis and the highest age was 31 to 40 years. Drug change and the incidence of neutropenia, thrombocytopenia and eosinophilia were also observed in some patients. Thus, it can be suggested that patients with refractory schizophrenia treated in the Specialized Component of Pharmaceutical Care of Piauí, are having a multiprofessional follow-up, especially the pharmacist who provides patient care at the time of dispensation, very effective.

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Continuing clozapine treatment with lithium in schizophrenic patients with neutropenia or leukopenia: brief review of literature with case reports

Abstract: Lithium increases neutrophil and total white blood cell count as a side effect that may be useful in patients who develop neutropenia or leukopenia while being treated with clozapine.

Cited by 27 publications

References 39 publications

Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats

Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats

Very Late-Onset Neutropenia in a Japanese Schizophrenia Patient Treated with Clozapine

Perfil do leucograma em pacientes com esquizofrenia refratária que usam clozapina

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