Reversible leucopenia related to olanzapine

Meissner, Wassilios G.; Schmidt, Tamara; Kupsch, Andreas; Trottenberg, Thomas; Lempert, Thomas

doi:10.1002/1531-8257(199909)14:5<872::aid-mds1026>3.0.co;2-y

Cited by 30 publications

(5 citation statements)

References 8 publications

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“…The hematological safety of olanzapine was questioned after some cases of granulocytopenia due to clozapine though persisting after a switch to olanzapine were reported [4,15,26]. By now, several cases of olanzapine-induced neutropenia or leukopenia have been reported by AMSP (38) as well as by other authors [6,9,29,31,41,42]. Some authors claimed the hematological safety of olanzapine based on case reports about successful treatment [14,40] even in patients who had developed blood dyscrasias previously on clozapine and risperidone [11] or on clozapine alone [32].…”

Section: Discussionmentioning

confidence: 99%

Blood Dyscrasias Induced by Psychotropic Drugs

2004

Pharmacopsychiatry

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Drugs can cause a variety of blood dyscrasias, e. g., by interfering with hematopoiesis in the bone marrow or damaging mature blood cells by antibodies. Although numerous reports on the risks of adverse hematological effects associated with psychotropic drugs have led to stringent monitoring requirements for some compounds, particularly neuroleptics, it is still difficult to estimate the true prevalence of such risks. Sixteen episodes of thrombocytopenia, 63 of neutropenia, 22 of agranulocytosis, 4 episodes of severe neutro- and thrombocytopenia, and 2 of pancytopenia were documented by the drug safety program in psychiatry AMSP (Arzneimittelsicherheit in der Psychiatrie) in a population of 122,562 patients between 1993 and 2000. All cases were related to the epidemiological data provided for this population and systematically analyzed as regards history of medication, co-medication, and the clinical course. Putative risk rates for the main groups of medications and a number of drugs could be estimated with this database. Most changes in the white blood cell counts, which were rated as probably or definitely drug-induced, were attributed to clozapine (0.18 % of patients exposed), carbamazepine (0.14 %) and perazine (0.09 %). In patients on newer atypical neuroleptics, we documented neutropenia assumed to be probably or definitely drug-related in five patients during treatment with olanzapine and in one case with risperidone. In all five olanzapine-related cases, the drugs were the sole cause of the adverse drug reactions. All surveyed patients who received clozapine showed no difference in age and gender distribution from those who developed hematological changes. Incidences of hematological changes for antidepressants were much lower (about 0.01 %). Although the methodological accuracy of these findings has to be critically discussed these data could be of considerable clinical relevance and should be helpful in making clinical treatment decisions.

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Section: Discussionmentioning

confidence: 99%

Blood Dyscrasias Induced by Psychotropic Drugs

2004

Pharmacopsychiatry

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“…In addition, binding affinities have been shown for adrenergic, histamine H1 and cholinergic muscarinic receptors. Adverse effects include drowsiness, sedation, dizziness, dry mouth, elevation in liver enzymes without clinical correlate and it may rarely induce neutropenia [112,113]. A double‐blind placebo‐controlled trial that was designed to compare clozapine with olanzapine was discontinued because of worsening parkinsonism with olanzapine [99].…”

Section: Olanzapinementioning

confidence: 99%

Treatment of behavioural symptoms and dementia in Parkinson's disease

Hanağası¹,

Emre

2005

Fundamemntal Clinical Pharma

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Behavioural symptoms such as anxiety, depression and psychosis are common in Parkinson's disease (PD), and dementia occurs in about 90% of the patients. These symptoms can be more disabling than the motor dysfunction and they negatively impact quality of life, increase caregiver distress and are more frequently associated with nursing home placement. Depression can be treated with counselling and pharmacotherapy. Tricyclic antidepressants or selective serotonin reuptake inhibitors are widely used, but there is still need for controlled clinical trials. Management of psychosis in PD is complex and includes elimination of identifiable risk factors, reduction of polypharmacy and administration of atypical neuroleptics, which can alleviate psychotic symptoms without worsening motor functions. Clozapine is the best documented atypical neuroleptic shown to be effective against psychosis in PD patients. Cholinesterase inhibitors may prove additional benefit in psychotic PD patients. Recent evidence from small double-blind and open-label trials suggests that cholinesterase inhibitors may be effective in the treatment of dementia associated with PD.

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“…In one of these cases, olanzapine-induced neutropenia occurred 5 days after resolution of previous clozapine-induced neutropenia [6,87]. Furthermore, Meissner and colleagues recently reported two parkinsonian patients who developed reversible leucopenia while being treated with olanzapine, both had a history of clozapine-induced leucopenia [81].…”

Section: Olanzapinementioning

confidence: 99%