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Clozapine and blood dyscrasia

  • Zahid Latif (a1), Faraz Jabbar (a2) and Brendan D. Kelly (a2)

Clozapine is an effective antipsychotic medication but is associated with agranulocytosis, neutropenia and leucopenia. The reintroduction of clozapine improved management of treatment-resistant schizophrenia, yet resulted in a paradoxical situation whereby the risk of blood dyscrasias is rigorously managed but other adverse effects (e.g. seizures, cardiovascular complications) are less well monitored. Monitoring of weight, lipids, plasma glucose and other metabolic parameters is recommended. There is also a need to reconsider routine haematological monitoring with other medications associated with blood dyscrasia (e.g. phenothiazines, carbamazepine). In particular, individuals who develop clozapine-induced blood dyscrasia may require haematological monitoring during treatment with other antipsychotics.

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1 Crilly, J. The history of clozapine and its emergence in the US market: a review and analysis. Hist Psychiatry 2009; 18;3960.
2 Kane, J, Honigfeld, G, Singer, J, Meltzer, H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–96.
3 Pirmohamed, M, Park, K. Mechanism of clozapine-induced agranulocytosis. CNS Drugs 1997; 7: 139158.
4 Gerson, SL. Clozapine – deciphering the risks. N Engl J Med 1993; 329: 204–5.
5 Gerson, SL. G-CSF and the management of clozapine-induced agranulocytosis. J Clin Psychiatry 1994; 55: 139–42.
6 Atkin, K, Kendall, F, Gould, D, Freeman, H, Lieberman, J, O'Sullivan, D. Neutropenia and agranulocytosis in patients receiving clozapine in the UK and Ireland. Br J Psychiatry 1996; 169: 483–8.
7 Dunk, LR, Annan, LJ, Andrews, CD. Rechallenge with clozapine following leucopenia or neutropenia during previous therapy. Br J Psychiatry 2006; 188: 255–63.
8 Munro, J, O'Sullivan, D, Andrews, C, Arana, A, Mortimer, A, Kerwin, R. Active monitoring of 12760 clozapine recipients in the UK and Ireland: beyond pharmacovigilance. Br J Psychiatry 1999; 175: 576–80.
9 Kelly, DL, Kreyenbuhl, J, Dixon, L, Love, RC, Medoff, D, Conley, RR. Clozapine underutilization and discontinuation in African Americans due to leucopenia. Schizophr Bull 2007; 33: 1221–4.
10 Williams, DP, Pirmohamed, M, Naisbitt, DJ, Maggs, JL, Park, BK. Neutrophil cytotoxicity of the chemically reactive metabolite(s) of clozapine: possible role in agranulocytosis. J Pharmacol Exp Ther 1997; 283: 1375–82.
11 Sackett, DL, Rosenberg, WM, Gray, JA, Haynes, RB, Richardson, WS. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71–2.
12 Esposito, D, Hardy, P, Corruble, E. Clozapine treatment following blood dyscrasia. Br J Psychiatry 2006; 189: 186.
13 Ghaznavi, S, Nakic, M, Rao, P, Hu, J, Brewer, JA, Hannestad, J, Bhagwagar, Z. Rechallenge with clozapine following neutropenia: treatment options for refractory schizophrenia. Am J Psychiatry 2008; 165: 813–8.
14 Taylor, D, Paton, C, Kapur, S. The South London and Maudsley NHS Foundation Trust and Oxleas NHS Foundation Trust Prescribing Guidelines (10th edn). Informa Healthcare, 2009.
15 Whiskey, E, Taylor, D. Restarting clozapine after neutropenia: evaluating the possibilities and practicalities. CNS Drugs 2007; 21: 2535.
16 Dernovsek, Z, Tavcar, R. Risperidone induced leucopenia and neutropenia. Br J Psychiatry 1997; 171: 393–4.
17 Thangadurai, P, Jyothi, KS, Gopalakrishnan, R, Kuruvilla, A, Jacob, KS. Reversible neutropenia with olanzapine following clozapine-induced neutropenia. Am J Psychiatry 2006; 163: 1298.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
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Clozapine and blood dyscrasia

  • Zahid Latif (a1), Faraz Jabbar (a2) and Brendan D. Kelly (a2)
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