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Rapid-onset agranulocytosis in a patient treated with clozapine and lamotrigine
Anna Emilia Urban1, Mariusz S Wiglusz, Wiesław Jerzy Cubała
1Department of Psychiatry, Medical University of Gdańsk, Dębinki 7 St. build. 25, 80-952 Gdańsk, Poland.
Background:
Clozapine is the treatment of choice in drug-resistant schizophrenia. Lamotrigine is a mood stabiliser recommended as combined treatment strategy in clozapine-resistant patients. There are cases of late-onset agranulocytosis reported in literature. Some are associated with clozapine or lamotrigine, others with the combination of both.
Case Report:
The article presents a case of rapid-onset agranulocytosis in a 60-year old clozapine-resistant patient, in whom lamotrigine was introduced as potentiation strategy. Discontinuation of both substances and GCSF treatment resulted in normalization of the absolute neutrophil count.
Conclusions:
The case suggests a possibility of developing rapid-onset agranulocytosis in clozapine-resistant patients who require lamotrigine as augmentation strategy. This emphasises the significance of monitoring a patient's blood count and early management of any dyscrasias noticed.
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