clozapine and Thrombocytopenia

Clozapine is associated with various haematological adverse effects, including leukopenia, neutropenia, agarnulocytosis, leukocytosis, anaemia, eosinophilia, thrombocytopenia and thrombocythaemia. Recognition and treatment of clozapine-related seizures also will become increasingly important as clozapine use grows in the 1990s. The decision to stop clozapine as a result of haematological adverse effects or seizures is a frustrating one for the clinician, and frequently disastrous for the patient. Cessation of treatment results in relapse. In case that patient is unresponsive to other antipsychotic, restarting clozapine should be consider, despite the risk involved. As the risk of a second agranulocytosis is much higher in those patients, various methods of militating against repeat blood dyscrasias have been treated, including granulocyte colony-stimulating factor and lithium. The decision to restart clozapine should be taken on case-by-case basis and should take into account the likely risks and benefits of restarting. Prior response to clozapine and magnitude of patient deterioration on stopping treatment are important factors to take into this consideration. Clozapine-related seizures did not preclude successful treatment with clozapine. A strategy that has been proposed to reduce the occurrence of seizures is the addition of an anticonvulsant agent. However, clozapine does induce a variety of adverse effects, most of which are of limited duration and either preventable or manageable if a number of simple clinical procedures are followed. With careful haematologyc control, the risk of agranulocytosis can be minimized and in case of clozapine related seizures recommendations include dose reduction, electroencephalogram (EEG), plasma-level monitoring and prophylactic antiepileptic treatment. Re-exposure to clozapine may rarely be attempted where there are facilities for very close and frequent monitoring.

Topics: Adult; Agranulocytosis; Anticonvulsants; Antimanic Agents; Antipsychotic Agents; Clozapine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Epilepsy; Female; Humans; Leukopenia; Lithium Carbonate; Psychotic Disorders; Recurrence; Risk Factors; Schizophrenia; Substance Withdrawal Syndrome; Thrombocytopenia

To evaluate the incidence of clozapine induced haematological side effects among patients receiving clozapine.. Data of 333 patients who were on clozapine for a mean duration of 52.96 (45.18) months were reviewed for haematological abnormalities.. Clozapine is associated eosinophilia and thrombocytopenia, which are often benign and in majority of the patients these normalize with time.

Topics: Adolescent; Adult; Aged; Anemia; Antipsychotic Agents; Clozapine; Drug-Related Side Effects and Adverse Reactions; Eosinophilia; Female; Hematologic Diseases; Humans; Incidence; India; Male; Middle Aged; Neutropenia; Psychotic Disorders; Retrospective Studies; Schizophrenia; Thrombocytopenia; Young Adult

Topics: Antipsychotic Agents; Clozapine; Humans; Schizophrenia; Thrombocytopenia

Topics: Antipsychotic Agents; Clozapine; Diagnostic and Statistical Manual of Mental Disorders; Drug Monitoring; Drug Resistance; Female; Hearing Loss, Sensorineural; Humans; Middle Aged; Psychiatric Status Rating Scales; Remission Induction; Schizophrenia; Schizophrenic Psychology; Thrombocytopenia; Treatment Outcome

Clozapine has shown superior efficacy over other antipsychotics. However, its use is complicated by the development of life-threatening hematologic adverse effects.. This paper reports the incidence of clozapine-induced hematologic toxicity in Saudi Arab patients.. King Khalid University Hospital, Riyadh, Saudi Arabia.. Medical data of Saudi Arab hospitalized patients receiving clozapine was retrospectively reviewed during the period between August 2009 and August 2012. White blood cell (WBC) counts and differentials were recorded in a specific form to watch for any hematologic toxicity. The hematologic toxicities included in this report are: eosinophilia, thrombocytopenia, lymphocytopenia, and agranulocytosis/neutropenia/leukopenia combined.. Complete WBC count.. During the study period 147 charts were reviewed. The mean age of patients was 38 ± 11.42 years and 52 % were males. During the study period 61 patients (42 %) developed 82 blood dyscrasias. Sixteen patients (10.9 %) developed agranulocytosis, neutropenia and leukopenia combined, while nineteen patients (12.9 %) developed lymphocytopenia, and seven patients (4.8 %) developed thrombocytopenia. Eosinophilia developed in 40 patients (27.2 %). During the first 18 weeks of therapy with clozapine, 21 (26 %) hematologic side effects were developed.. The data collected in this study does appear to indicate there may be an increased incidence of blood dyscrasias in Saudi Arabs which warrants further, more detailed, study. It would be of concern to psychiatric clinicians if the case of a genetic predisposition to clozapine-induced blood dyscrasias were proven in the future.

Topics: Adult; Antipsychotic Agents; Clozapine; Drug Monitoring; Drug Therapy, Combination; Eosinophilia; Female; Hospitals, University; Humans; Incidence; Leukocyte Count; Leukopenia; Male; Medical Records; Middle Aged; Platelet Count; Retrospective Studies; Saudi Arabia; Severity of Illness Index; Thrombocytopenia

In this retrospective study, we aimed to evaluate platelet changes in patients taking clozapine for a variety of psychiatric disorders and hypothesized that there would be any changes in the course of the treatment.. Diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders 4(th) edition. Forty-three patients, with the mean age of 36.23 ± 6.35 years were included into final analysis. Morning venous blood samples were used for platelet counts. Correlation analyses were performed between platelet counts and clozapine doses.. Paired t test did not reveal a significant change in platelet counts at the end visit compared to those of first assessment (p>0.05). Seven (17.9%) of 39 patients had platelet count below 180000 per cubic millimeter at least one time during their clozapine use. In five of these patients, the platelet count returned to a level above 180000 per cubic millimeter, without any dose change or other interventions. On the other hand, as for the issue of increased platelet count, results demonstrated that seven (17.9%) had platelet count above 400000 per cubic millimeter at least one time during clozapine use.. The present investigation revealed that platelet changes beyond WBC changes should be taken into consideration when using clozapine. Clinicians should be aware of the deviations from absolute threshold values.

Topics: Adult; Antipsychotic Agents; Blood Platelets; Clozapine; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Mental Disorders; Middle Aged; Platelet Count; Prognosis; Retrospective Studies; Thrombocytopenia; Thrombocytosis; Young Adult

Topics: Anti-Infective Agents; Bipolar Disorder; Chronic Disease; Clozapine; Drug Synergism; Female; Humans; Middle Aged; Neutropenia; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antipsychotic Agents; Clozapine; Fluphenazine; Humans; Male; Schizophrenia; Thrombocytopenia

Clozapine is a dibenzodiazepine derivative that is more effective than standard neuroleptic drugs in refractory schizophrenic patients, but its introduction in some countries was delayed by its propensity to cause blood dyscrasias. However, over the last ten years, different reports have clearly demonstrated that agranulocytosis and neutropenia can be easily prevented by means of strict hematologic surveillance. This article reviews the results of the first five years of the Italian Clozapine Monitoring System (ICLOS).. The hematologic parameters of 2,404 patients registered between 1995 and 1999 were collected in a central database, before the patients began clozapine-treatment, weekly for the first 18 weeks, and then monthly throughout the duration of therapy. On the basis of conventional criteria, different risk levels have been identified with total leukocyte <3. 0x10(9)/L and/or an absolute neutrophil count <1.5x10(9)/L leading to immediate discontinuation of the drug.. The analysis shows that 0.9% of the patients developed neutropenia and 0.7% agranulocytosis, mainly during the first 18 weeks of clozapine treatment. Drug discontinuation led to the normalization of hematologic parameters in all cases, and the use of growth factors reduced the risk of infectious complications. Transient leukocytosis and eosinophilia were also observed but these did not have any serious clinical effects.. The ICLOS study confirms that regular hematologic monitoring is highly effective in minimizing the incidence of clozapine-associated blood dyscrasias. The lower than initially expected rates of agranulocytosis and associated deaths are encouraging in view of the benefits of this drug in treatment-resistant schizophrenia and other neurologic disorders.

Topics: Adult; Agranulocytosis; Antipsychotic Agents; Clozapine; Eosinophilia; Female; GABA Antagonists; Granulocyte Colony-Stimulating Factor; Humans; Incidence; Italy; Leukocytosis; Male; Middle Aged; Neutropenia; Paraproteinemias; Retrospective Studies; Risk Factors; Schizophrenia; Serotonin Antagonists; Thrombocytopenia

Topics: Antipsychotic Agents; Clozapine; Humans; Male; Middle Aged; Schizophrenia; Thrombocytopenia

In patients with Parkinson' disease and dopaminergic psychosis, clozapine treatment is recommended as the drug is free from extrapyramidal side effects and does not worsen motor symptoms of the underlying disease. The use of clozapine, however, is limited due to its hematotoxic side effects. For treatment of clozapine-induced agranulocytosis, granulocyte colony-stimulating factors (G-CSF) are recommended. We report the case of a 72-years-old male patient with clozapine-induced agranulocytosis and thrombopenia. Neutropenia was successfully treated with G-CSF, but thrombopenia persisted and resolved spontaneously after 14 days. Bone marrow toxicity of clozapine is not restricted to white cell maturation, but may also impair thrombocytopoesis.

Topics: Aged; Agranulocytosis; Antiparkinson Agents; Antipsychotic Agents; Clozapine; Dopamine Agents; Humans; Leukocyte Count; Male; Parkinson Disease; Platelet Count; Psychoses, Substance-Induced; Thrombocytopenia

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

Topics: Adult; Antipsychotic Agents; Clozapine; Disseminated Intravascular Coagulation; Humans; Male; Neuroleptic Malignant Syndrome; Thrombocytopenia

Clozapine, an atypical antipsychotic agent used in cases of treatment-resistant schizophrenia, is known for its relative absence of extrapyramidal side effects and its potential hazardous effect on white blood cell function. We have described a case of clozapine-associated epistaxis and reduction of the platelet count. Discontinuance of clozapine therapy resulted in cessation of epistaxis followed by normalization of the platelet count. We suggest routine monitoring of platelet count and function in patients treated with clozapine.

Topics: Amobarbital; Blood Cell Count; Clozapine; Delayed-Action Preparations; Diazepam; Drug Monitoring; Drug Therapy, Combination; Epistaxis; Fluphenazine; Hemoglobins; Humans; Male; Middle Aged; Platelet Count; Schizophrenia, Paranoid; Thrombocytopenia