OBJECTIVE: To review recent work on the haematological toxicity of clozapine and some other drugs used in psychiatry concerning especially (i) the mechanism of antipsychotic-induced neutropenia/agranulocytosis, (ii) criteria for clozapine prescribing in benign ethnic neutropenia, (iii) options in the event of worrying falls in white cell count (WCC), including measures to boost WCC with or without continued clozapine administration, (iv) criteria for clozapine rechallenge in the event that treatment was suspended because of a fall in WCC and (v) safety concerns regarding clozapine in children/adolescents. CONCLUSIONS: There remain several difficult areas, including the criteria for clozapine rechallenge. Experience has emphasised (i) the role of appropriate timing of WCC sample collection to ensure that clozapine is not withdrawn unnecessarily and (ii) the success of agents such as filgrastim in promoting rapid production of granulocytes if the situation so demands. On the other hand, the use of lithium to promote a leucocytosis has taken hold without a clear risk: benefit analysis. Be this as it may, should patients decide that they no longer wish to undergo WCC monitoring after 12 months on clozapine, cessation of monitoring is probably preferable to stopping the drug since overall mortality is decreased in patients treated with clozapine.
OBJECTIVE: To review recent work on the haematological toxicity of clozapine and some other drugs used in psychiatry concerning especially (i) the mechanism of antipsychotic-induced neutropenia/agranulocytosis, (ii) criteria for clozapine prescribing in benign ethnic neutropenia, (iii) options in the event of worrying falls in white cell count (WCC), including measures to boost WCC with or without continued clozapine administration, (iv) criteria for clozapine rechallenge in the event that treatment was suspended because of a fall in WCC and (v) safety concerns regarding clozapine in children/adolescents. CONCLUSIONS: There remain several difficult areas, including the criteria for clozapine rechallenge. Experience has emphasised (i) the role of appropriate timing of WCC sample collection to ensure that clozapine is not withdrawn unnecessarily and (ii) the success of agents such as filgrastim in promoting rapid production of granulocytes if the situation so demands. On the other hand, the use of lithium to promote a leucocytosis has taken hold without a clear risk: benefit analysis. Be this as it may, should patients decide that they no longer wish to undergo WCC monitoring after 12 months on clozapine, cessation of monitoring is probably preferable to stopping the drug since overall mortality is decreased in patients treated with clozapine.
Authors: Simone De Jong; Marjolein Neeleman; Jurjen J Luykx; Maarten J ten Berg; Eric Strengman; Hanneke H Den Breeijen; Leon C Stijvers; Jacobine E Buizer-Voskamp; Steven C Bakker; René S Kahn; Steve Horvath; Wouter W Van Solinge; Roel A Ophoff Journal: Hum Mol Genet Date: 2014-01-07 Impact factor: 6.150
Authors: Domenico De Berardis; Gabriella Rapini; Luigi Olivieri; Domenico Di Nicola; Carmine Tomasetti; Alessandro Valchera; Michele Fornaro; Fabio Di Fabio; Giampaolo Perna; Marco Di Nicola; Gianluca Serafini; Alessandro Carano; Maurizio Pompili; Federica Vellante; Laura Orsolini; Giovanni Martinotti; Massimo Di Giannantonio Journal: Ther Adv Drug Saf Date: 2018-02-06
Authors: Roland Seifert; Andrea Strasser; Erich H Schneider; Detlef Neumann; Stefan Dove; Armin Buschauer Journal: Trends Pharmacol Sci Date: 2012-12-17 Impact factor: 14.819