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Treatment of clozapine- and molindone-induced agranulocytosis with granulocyte colony-stimulating factor
1Department of Pharmaceutical Services, Saint Mary's Health Services, Grand Rapids, MI 49503.
Objective:
To report a case of clozapine- and molindone-induced agranulocytosis and to discuss treatment using filgrastim, a granulocyte colony-stimulating factor.
Case Summary:
A 64-year-old woman who had been on long-term clozapine therapy for schizophrenia was hospitalized with presumed drug-induced agranulocytosis. She had also been on short-term molindone therapy. A bone marrow biopsy and the initial white blood cell (WBC) count were consistent with drug-induced agranulocytosis. Following seven days of treatment with subcutaneous filgrastim 300 micrograms/d, her absolute neutrophil count was above 500 x 10(6)/L.
Discussion:
Reports in the literature discussing antipsychotic drug-induced agranulocytosis are reviewed. A relationship between treatment with filgrastim and WBC response is postulated.
Conclusions:
Filgrastim may be useful in ameliorating the effects of clozapine- and molindone-induced agranulocytosis.