Granulocytopenia With Clozapine and Quetiapine

Diaz, Pablo; Hogan, Thomas P.

doi:10.1176/appi.ajp.158.4.651

Cited by 20 publications

(5 citation statements)

References 3 publications

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“…Furthermore, only three cases have been described in the literature for this form of treatment [80][81]. All three One open-label study [83] and one case report [84] have been published on clozapine-quetiapine combination therapy. Reinstein et al [83] performed an open-label study of 65 patients who had responded to clozapine after 6 months but had developed diabetes.…”

Section: Atypical-clozapine Antipsychotic Polypharmacymentioning

confidence: 99%

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A Critical Review of Atypical Antipsychotic Utilization: Comparing Monotherapy with Polypharmacy and Augmentation

Stahl¹,

Mm²

2004

CMC

159

118

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The atypical antipsychotics risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole have become first-line treatment for schizophrenia because they reduce the positive symptoms of psychosis but do not have a high incidence of extrapyramidal symptoms. However, these agents, like other antipsychotics, may take as long as 16 or more weeks to produce a response, and even with prolonged treatment are unlikely to evoke responses greater than 50% improvement in symptoms. This has led to the experimental use of high atypical antipsychotic doses, antipsychotic polypharmacy, and augmentation with other psychotropic drugs, all of which occur commonly in clinical practice. This article reviews the current evidence for these increasingly common means of treating schizophrenia and psychosis, with particular emphasis on polypharmacy and augmentation. To date, there are only two controlled studies of antipsychotic polypharmacy involving an atypical antipsychotic; the rest of the data are uncontrolled trials and case reports that describe a mixture of positive and negative findings. One multicenter, double-blind trial shows a faster onset of action when divalproex is added to risperidone or olanzapine than with antipsychotic monotherapy. A small double-blind study demonstrates efficacy when lamotrigine is added to clozapine. The rest of the data on augmentation with anticonvulsants are uncontrolled, and most report adverse effects. With the exception of divalproex, there are currently no compelling data to justify the use of antipsychotic polypharmacy or augmentation. Existing evidence suggests that the best treatments for schizophrenia and psychosis may be long-term trials of a sequence of atypical antipsychotic monotherapies at therapeutic doses.

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Section: Atypical-clozapine Antipsychotic Polypharmacymentioning

confidence: 99%

“…Combination therapy resulted in significant weight loss and lowered rates of diabetes mellitus. The only other published report of clozapine-quetiapine polypharmacy is a case in which a patient's neutrophil count dropped from 1,800/mm 3 to 1,400/mm 3 when quetiapine was cross-titrated with clozapine [84].…”

Section: Atypical-clozapine Antipsychotic Polypharmacymentioning

confidence: 99%

A Critical Review of Atypical Antipsychotic Utilization: Comparing Monotherapy with Polypharmacy and Augmentation

Stahl¹,

Mm²

2004

CMC

159

118

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“…Two reports concerning clozapine plus quetiapine were identified (Table 1). One case of decreased neutrophil count and significant clinical deterioration during a gradual switch from clozapine to quetiapine was also reported, 110 although this was not a prospective polypharmacy study. All patients lost weight (0.22-10 kg, mean 1.8 kg) after one month of combination therapy, with a mean weight loss of 4.2 kg (0.45-18.6 kg) over the 10-month study period.…”

Section: Clozapine Plus Olanzapinementioning

confidence: 99%

Polypharmacy With Second-Generation Antipsychotics: A Review of Evidence

Pandurangi

Dalkılıç²

2008

Journal of Psychiatric Practice

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“…Case reports of persistence of agranulocytosis after switches to olanzapine, risperidone, and quetiapine have been reported with the recommendation for close hematological monitoring in situations where an atypical antipsychotic is used in close temporal proximity to clozapine (40)(41)(42). Granulocyte counts should be continued for at least 4 weeks after clozapine is discontinued.…”

Section: Clozapinementioning

confidence: 99%

Switching atypical antipsychotics: a review

Chue

Stip

Remington

et al. 2004

Acta Neuropsychiatr.

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Despite the prevalence of switching in real world clinical practice, there is a paucity of data to guide clinicians with respect to effective and safe strategies. There are no criteria defining a successful switch. With the increasing range and formulations of atypical antipsychotics available, there is a rationale for their early use to avoid the practical problems associated with switching from conventional antipsychotics as well as the opportunity to maintain patients on an optimal atypical antipsychotic monotherapy.

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Granulocytopenia With Clozapine and Quetiapine

Cited by 20 publications

References 3 publications

A Critical Review of Atypical Antipsychotic Utilization: Comparing Monotherapy with Polypharmacy and Augmentation

A Critical Review of Atypical Antipsychotic Utilization: Comparing Monotherapy with Polypharmacy and Augmentation

Polypharmacy With Second-Generation Antipsychotics: A Review of Evidence

Switching atypical antipsychotics: a review

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