clozapine and Lymphopenia

The authors provide the data on the dynamics of the hematological parameters during continuous leponex (clozapin) treatment of two group of patients treated in 1973-1989 at the All-Union Mental Health Research Center, USSR AMS (107 patients) and at 12 Research Centers of the USSR, CSFR, Bulgaria and Poland (642 patients). The mean duration of the treatment was 4.8 and 12.4 months respectively. Moderate leukopenia (3000-4000/ml) developed in 0.5 and 1.2% of all the analyses, the neutrophil/leukocyte ratio always remained within normal (50% and higher), whereas the neutrophil count did not drop below 1600/ml, i. e. it was not pathological. Despite the relatively long treatment no cases of granulocytopenia (or agranulocytosis) were recorded. It is shown that the side hematological effect is not related to the magnitude of the diurnal dose of leponex. Recommendations are given for wide use of leponex in medical practice under constant control of the blood status, with the use of the method of a slow and progressive augmentation of the daily dose.

Topics: Adult; Agranulocytosis; Clozapine; Drug Monitoring; Europe, Eastern; Female; Granulocytes; Humans; International Cooperation; Leukocyte Count; Lymphocytes; Lymphopenia; Male; Middle Aged; Schizophrenia, Catatonic; USSR

Monitoring of white cell counts during clozapine treatment leads to cessation of therapy if levels fall below predetermined values. Reductions in white cell counts, driven by lower levels of lymphocytes, have been observed with coronavirus disease 2019 (COVID-19). Neutropenia during COVID-19 has not been reported. We present data for 56 patients who were taking clozapine and had COVID-19.. We included patients who were taking clozapine at the time they tested positive for COVID-19. We compared absolute neutrophil counts, lymphocyte counts and white cell counts between baseline and the first week of infection, and baseline and the second week of infection.. We observed reductions in absolute neutrophil counts (p = 0.005), lymphocyte counts (p = 0.003) and white cell counts (p < 0.001) between baseline and the first 7 days of COVID-19. All cell counts had returned to baseline levels by days 8 to 14. Six patients experienced neutropenia (absolute neutrophil counts < 2.0 × 109/L) and of those, 4 underwent mandatory cessation of clozapine. For 3 patients, clozapine treatment had been established for more than 6 months with no previous neutropenia, neutrophil levels returned to baseline within 2 weeks and no further neutropenia was observed on restarting treatment.. This was a retrospective chart review; larger cohorts are required. Clozapine plasma levels were largely not measured by clinicians.. These data strongly suggest that mild neutropenia in the acute phase of COVID-19 in patients who are well established on clozapine is more likely to be a consequence of the virus than of clozapine treatment.

Topics: Adult; Aged; Aged, 80 and over; Antipsychotic Agents; Clozapine; COVID-19; Female; Humans; Leukocyte Count; Leukopenia; Lymphocyte Count; Lymphopenia; Male; Middle Aged; Neutropenia; Neutrophils; Psychotic Disorders; Retrospective Studies; SARS-CoV-2; Schizophrenia; Young Adult

The atypical antipsychotic clozapine is associated with several well-known abnormalities of blood cell count, whereas only rare reports are associated with the neuroleptic risperidone. This report describes lymphocytopenia and thrombocytopenia under treatment with risperidone which continued after changing to clozapine without other clinically significant abnormal hematological parameters. Within one week after discontinuation of both neuroleptics abnormalities of blood cell count reversed to the initial values. Abnormalities of lymphocytes or thrombocytes are rare side-effects under treatment with risperidone or clozapine.

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Lymphopenia; Male; Risperidone; Thrombocytopenia