Fluoxetine-induced neutropenia

Bavle, Amar

doi:10.4103/0019-5545.104841

Cited by 5 publications

(2 citation statements)

References 3 publications

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“…Although there has not been a clear link between Fluoxetine and neutropenia, there have been case reports of fluoxetine-induced neutropenia. 11 , 12 However, this patient was neutropenic prior to starting fluoxetine and his WBC and ANC levels did not appear to change with higher doses of fluoxetine. Therefore, fluoxetine was an unlikely source of this patient’s neutropenia.…”

Section: Discussionmentioning

confidence: 81%

Olanzapine-induced neutropenia

Malhotra¹,

Vu²,

Wang³

et al. 2015

Mental Illness

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Olanzapine-induced neutropenia is a rare adverse effect that is currently poorly described in literature. Although neutropenia is a known adverse effect of clozapine, it has been associated with the use of other antipsychotic medications like olanzapine. This case report describes and reviews a case of olanzapine-induced neutropenia in a schizophrenic patient. Although the mechanism of antipsychotic-induced neutropenia is still debated, this report attempts to discuss current theories as well as supply evidence in literature of this rare but potentially dangerous adverse effect.

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Section: Discussionmentioning

confidence: 81%

Olanzapine-induced neutropenia

Malhotra¹,

Vu²,

Wang³

et al. 2015

Mental Illness

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“…Nonetheless, in selecting antipsychotics for treatment of patients recovering from clozapine-induced neutropenia or agranulocytosis, clinicians should be cautious and restrict their use of agents with a documented history of neutropenia, such as olanzapine (27). In addition to olanzapine potentially exacerbating or protracting the patients neutropenia, we considered two other concurrent medications, fluoxetine and mirtazapine, that could have theoretically contributed to neutropenia (28, 29). However, neutropenia due to fluoxetine has been rarely reported and mirtazapine was discontinued three months prior to L.F. developing neutropenia.…”

Section: Discussionmentioning

confidence: 99%

Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review

Boazak¹,

Kahn²,

Cox

et al. 2018

Clinical Schizophrenia & Related Psychoses

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Clozapine-induced neutropenia occurs in 3-5% of individuals treated with clozapine. Current US guidelines require interruption of clozapine when the absolute neutrophil count (ANC) drops below 1000 cells/mm. There is minimal available guidance for what dosing schedule to use when restarting clozapine after an episode of neutropenia. Here, we present a case of a 50-year-old Caucasian female with a history of schizoaffective disorder who was successfully rechallenged on clozapine one month after developing clozapine-induced neutropenia (ANC 600 cells/mm). To understand published re-titration rates of clozapine after neutropenia, we conducted a literature review using a using the PubMed database and found only seven case reports that unambiguously reported a clozapine dosing schedule during re-challenge. All were successful except one, a case of clozapine rechallenge after agranulocytosis. Including this case presentation, six out of eight cases restarted clozapine more cautiously than recommended by the US guidelines for a new clozapine initiation. We cannot comment what role a slower or more rapid titration plays in a successful rechallenge after neutropenia with the available evidence. We encourage researchers to publish their dosing schedule in detail after an episode of neutropenia or agranulocytosis.

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