Neutropenia with Multiple Antipsychotics Including Dose Dependent Neutropenia with Lurasidone

Abstract

Antipsychotic-induced agranulocytosis is a significant side effect that is known to occur with most of the antipsychotic medications. It usually resolves once the medications are stopped and patients are able to be switched over to another anti-psychotic medication. Lurasidone has not been reported to cause leukopenia and neutropenia. This case report is of a patient with a past history of risperidone induced-aganulocytosis developing dose related leukopenia and neutropenia with lurasidone.

Letter to the Editor

“…While a literature search reveals no reports of cariprazine-associated neutropenia, neutropenia secondary to aripiprazole and lurasidone treatment has been reported 6,8,14–16 . Most cases of drug-associated neutropenia resolve within 1 month of medication cessation alone 2,17 .…”

“…13 While a literature search reveals no reports of cariprazine-associated neutropenia, neutropenia secondary to aripiprazole and lurasidone treatment has been reported. 6,8,[14][15][16] Most cases of drug-associated neutropenia resolve within 1 month of medication cessation alone. 2,17 While our patient's ANC may have increased after cessation of the lurasidone alone, given that she still had neutropenia 12 weeks after its cessation, we decided to initiate lithium.…”

“…Moreover, although drugassociated neutropenia is typically transient, a patient may develop recurrent neutropenia in the future with another medication. [4][5][6][7][8] Hence, awareness of ANC is clinically relevant, even when using non-clozapine antipsychotic medications. To our knowledge, there are no reported cases of non-clozapine antipsychotic medication-associated neutropenia lasting for longer than 1 month.…”

“…Although neutropenia may be asymptomatic, it can result in recurrent infections, fever, and sepsis. Moreover, although drug-associated neutropenia is typically transient, a patient may develop recurrent neutropenia in the future with another medication 4–8 . Hence, awareness of ANC is clinically relevant, even when using non-clozapine antipsychotic medications.…”

Lurasidone-induced anemia: Is there a need for hematological monitoring?

“…[4] Few case reports also mentioned agranulocytosis as a dose-dependent adverse effect of lurasidone, which reverted after reducing the dose. [5] Anemia is rarely reported as an adverse effect; one study has observed the occurrence of anemia with the use of lurasidone during premarketing evaluation of the drug. [6] As per the “medicine updates,” frequency of anemia caused by lurasidone is not known.…”