olanzapine and Neutropenia

This case report describes a case of a woman with treatment-resistant schizophrenia, who experienced neutropenia induced by olanzapine and clozapine, and reached symptomatic stabilization with a combination of two depot antipsychotics. This report presents a brief review about the incidence of haematologic events by antipsychotics and the evidence of antipsychotic combination in the treatment.

Topics: Adult; Antipsychotic Agents; Clozapine; Delayed-Action Preparations; Drug Resistance; Drug Therapy, Combination; Female; Humans; Neutropenia; Olanzapine; Schizophrenia

In this study, we report the case of a Chinese patient with systemic lupus erythematosus (SLE) who developed neutropenia after treatment by olanzapine for the SLE-related psychiatric symptoms. The relationship between agranulocytosis, SLE and olanzapine is still unknown. Fcγ receptor IIIb (FcγRIIIb) is a low-affinity receptor, constitutively expressed only by neutrophils; NA1 and NA2 have been identified as representing polymorphisms of FcγRIIIb. NA1 is associated with the incidence of autoimmune neutropenia and is particularly frequent in Asiatic ethnic groups. The Chinese patient resulted to be homozygous for NA1. We suggest that the presence of NA1 allele may be a predisposing factor to olanzapine-induced agranulocytosis in patients with SLE. Hence, the analysis of FcγRIIIb polymorphism should be investigated in other cases of antipsychotic-induced agranulocytosis.

Topics: Adult; Antipsychotic Agents; Asian People; Benzodiazepines; Ethnicity; Female; GPI-Linked Proteins; Humans; Lupus Erythematosus, Systemic; Mental Disorders; Neutropenia; Olanzapine; Polymorphism, Genetic; Receptors, IgG

Topics: Adult; Anticonvulsants; Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Chemical and Drug Induced Liver Injury; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Female; Humans; Lithium Carbonate; Liver Function Tests; Neutropenia; Olanzapine; Retreatment; Thrombocytopenia; Valproic Acid

Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Dibenzothiazepines; Female; Humans; Middle Aged; Neutropenia; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Blood Cell Count; Clozapine; Electroconvulsive Therapy; Female; Humans; Leukocyte Count; Neutropenia; Olanzapine; Patient Compliance; Recurrence; Schizophrenia, Paranoid

Neutropenia and agranulocytosis are risks known to occur with phenothiazines and clozapine. The mechanisms responsible for these conditions currently remain unclear. To our knowledge, no case of fatal agranulocytosis as a result of olanzapine treatment was reported in the literature. Thus any case of severe neutropenia occurring in a patient receiving olanzapine is alarming to clinicians. First, a review of the literature produced 41 anecdotic cases of neutropenia or agranulocytosis during treatment with olanzapine (Zyprexa) reported in a total of 24 publications. Second, we report a case of neutropenia, which proved to be fatal in a schizophrenia patient receiving olanzapine and thiazide. The cause of the death was Myelodysplastic syndrome. There is not enough evidence to prove the involvement of either olanzapine or hydrochlorothiazide or the interaction between them in this patient's myelodysplasia. Bone marrow cytogenetic study confirmed the deletion of the long arm of chromosome 11, as reported in myeloid leukemia. If this patient would have died suddenly without the laboratory investigations that lead to the diagnosis of myeloblastic leukemia, the cause would have been probably and wrongfully allotted to treatment with olanzapine.

Topics: Adult; Agranulocytosis; Antipsychotic Agents; Benzodiazepines; Blood Cell Count; Bone Marrow Cells; Fatal Outcome; Humans; Male; Myelodysplastic Syndromes; Neutropenia; Olanzapine; Schizophrenia, Paranoid

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Humans; Male; Neutropenia; Olanzapine; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Drug Therapy, Combination; Female; Humans; Neutropenia; Olanzapine; Schizophrenia

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Delayed-Action Preparations; Female; Humans; Leukopenia; Middle Aged; Neutropenia; Olanzapine; Schizophrenia

Topics: Adult; Agranulocytosis; Antipsychotic Agents; Benzodiazepines; Clozapine; Drug Monitoring; Humans; Leukocyte Count; Male; Neutropenia; Neutrophils; Olanzapine; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

Atypical antipsychotics, including olanzapine, were originally expected to reduce the risk of haematological toxicity and to be safe alternatives to clozapine. We report a case of patient who developed leucopenia and neutropenia during treatment with olanzapine.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Depressive Disorder, Major; Humans; Leukopenia; Male; Neutropenia; Olanzapine

Topics: Adolescent; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Blood Cell Count; Citalopram; Dose-Response Relationship, Drug; Female; Humans; Neutropenia; Olanzapine

Olanzapine is an atypical antipsychotic with a low incidence of extrapyramidal-motoric side effects. Its chemical structure is related to clozapine, which is known to induce neutropenia in up to 3% and agranulocytosis in approximately 1% of patients. It has been discussed controversially whether olanzapine also has a potential to induce neutropenia and agranulocytosis. Up to now, seven case reports of haematopoetic disturbances during olanzapine treatment have been published, including one case of olanzapine-induced agranulocytosis (Naumann et al. 1999), two cases of neutropenia (Steinwachs et al. 1999) and one leucopenia (Meissner et al. 1999). We report three subjects with reversible neutropenia under olanzapine, with rapid normalisation of neutrophil cell counts after discontinuation of olanzapine. In one case neutropenia occurred after administration of a single dose of olanzapine, in another case after 6 weeks of treatment. In both cases, patients had no clinical complications. In the third case, neutropenia appeared after 1.5 years of treatment followed by development of pneumonia. Two cases were recorded within the German drug surveillance project (AMSP); the third case was observed in a randomised, double-blind, multicentre study comparing olanzapine with clozapine.

Topics: Adult; Aged; Antipsychotic Agents; Atrophy; Benzodiazepines; Clozapine; Female; Frontal Lobe; Humans; Neutropenia; Olanzapine; Parietal Lobe; Schizophrenia

Topics: Adult; Agranulocytosis; Antipsychotic Agents; Benzodiazepines; Clozapine; Female; Humans; Leukocyte Count; Neutropenia; Olanzapine; Perphenazine; Pirenzepine; Risperidone; Schizophrenia

We report a 2-year experience with olanzapine treatment (20 mg daily) in a 65-year-old male patient with treatment-resistant paranoid schizophrenia, who had previously developed leucopenia and neutropenia first on clozapine and, subsequently, also on risperidone. Olanzapine seems to be safe in this patient, since no major decreases of haematological parameters were observed. The only exception was a brief decrease of leucocyte and neutrophil (but not erythrocyte or platelet) counts during influenza-like viral infection. However, the control of psychotic symptoms on olanzapine is not as good as on clozapine.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Clozapine; Drug Monitoring; Humans; Leukopenia; Male; Neutropenia; Olanzapine; Pirenzepine; Risk Factors; Risperidone; Schizophrenia, Paranoid

Topics: Adolescent; Adult; Antipsychotic Agents; Benzodiazepines; Bone Marrow; Female; Humans; Leukocyte Count; Leukopenia; Male; Neutropenia; Olanzapine; Pirenzepine; Risk Factors; Selective Serotonin Reuptake Inhibitors

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Leukocyte Count; Male; Middle Aged; Neutropenia; Olanzapine; Pirenzepine; Psychotic Disorders; Schizophrenia; Time Factors

Olanzapine is a new antipsychotic drug, pharmacodynamically similar to clozapine, but putatively devoid of haematological iatrogenicity. We report a case of relapse of previously clozapine-induced neutropenia after olanzapine treatment.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Female; Humans; Neutropenia; Olanzapine; Pirenzepine

Olanzapine is a tricyclic neuroleptic agent that due to structural similarities was expected to be a safe alternative to clozapine, which has a 0.5-2% risk of agranulocytosis. So far, only rare cases of leukocytopenia and thrombocytopenia have become known. In the association, "Drug Safety in Psychiatry", which is made up of 25 German psychiatric hospitals, two cases of olanzapine-induced neutropenia occurred in patients with chronic schizophrenia. The adverse drug reaction was noticed 17 days after the first intake of olanzapine in case 1 and more than 5 months after the first intake in case 2. In the second case, a reexposure to olanzapine caused the neutrophil cells to decrease again. There were no clinical signs of an infection, and the blood cell counts increased immediately to normal ranges after discontinuation of olanzapine. No special treatment was necessary.

Topics: Adult; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Female; Humans; Male; Neutropenia; Olanzapine; Pirenzepine; Time Factors