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Continuing clozapine treatment despite neutropenia
David Esposito1, Frédéric Rouillon, Frédéric Limosin
1Department of Psychiatry, Albert Chenevier Hospital (AP-HP), 40, rue de Mesly, 94000, Créteil, France.
Rationale:
Approximately 1-2% of patients treated with the atypical antipsychotic clozapine develop severe neutropenia and agranulocytosis. The usual recommendation is to discontinue treatment with the drug when the peripheral neutrophil count drops below 1,500/mm3.
Methods:
We have reviewed several reports describing procedures that allowed the patients to continue clozapine treatment despite the occurrence of these haematological side effects.
Results:
The therapeutic procedures described (symptomatic treatment of neutropenia by co-administration of lithium or granulopoiesis-stimulating factors, management of the adjunctive medication) seem to be efficient strategies that allow continuation of clozapine treatment despite the occurrence of neutropenia. However, these types of therapy have only been used in a limited number of cases, and the evidence supporting their use remains anecdotal.
Conclusion:
Although the procedures adopted in the cases described in this review are uncommon, they potentially provide an alternative to the discontinuation of clozapine treatment in patients with complex symptomatologies for whom treatment with other antipsychotic medication is insufficient.