quetiapine-fumarate and Neutropenia

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Female; Humans; Neutropenia; Quetiapine Fumarate; Schizophrenia; Sertraline; Young Adult

Extended release quetiapine fumarate (quetiapine XR) is a new formulation that allows once-daily dosing and a titration regimen that is simpler than that of immediate release quetiapine (quetiapine IR) and may potentially increase patients' adherence to their prescribed medication.. The tolerability of quetiapine XR was examined in an analysis of pooled data from three Phase III, double-blind, placebo-controlled, randomised studies with quetiapine IR as a reference treatment.. The overall incidence of adverse events (AEs) was similar for quetiapine XR (69.5%) and quetiapine IR (72.5%). Most AEs were mild to moderate in severity and in line with those observed with quetiapine IR. The more rapid dose titration of quetiapine XR did not produce any new safety concerns and was as well tolerated as the regimen for quetiapine IR.. The results of this pooled analysis show that quetiapine XR administered once daily is generally as well tolerated as quetiapine IR given twice daily. These data, together with the simpler dose-titration of quetiapine XR that allowed therapeutically effective doses to be reached by Day 2, suggest that this formulation potentially may improve adherence in patients with schizophrenia.

Topics: Acute Disease; Adolescent; Adult; Aged; Antipsychotic Agents; Clinical Trials, Phase III as Topic; Delayed-Action Preparations; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Double-Blind Method; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Neutropenia; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Schizophrenia; Young Adult

Topics: Administration, Intranasal; Adolescent; Antipsychotic Agents; Humans; Male; Neutropenia; New South Wales; Prescription Drug Diversion; Prisoners; Quetiapine Fumarate

To investigate whether the incidence of neutropenia was higher in subjects who received a combination treatment with valproate and quetiapine than in those who were administered monotherapy.. Retrospective cohort study.. Rehabilitation department of a university hospital.. Patients with acquired brain injuries who had taken valproate for seizures or quetiapine for delirium for >7 days (N=101). Data were extracted from electronic medical records of the hospital.. Not applicable.. Incidence of neutropenia (absolute neutrophil count<2000 cells/μL) was elicited from the weekly complete blood cell records for 71.07±43.71 days of observation. The odds ratio for neutropenia development was calculated and adjusted for variables that showed significant differences between patients with or without neutropenia.. The incidence of neutropenia was significantly higher in the group receiving the combination treatment than in those receiving the monotherapy (32.26% vs 12.90%, adjusted P=.036), despite a lack of any differences in the daily doses of the medications. Coadministration of quetiapine and valproate was the predictor of neutropenia development when age, body weight, and underlying diseases were adjusted in the logistic regression model (odds ratio=3.749; 95% confidence interval, 1.161-12.099; P=.027).. Administration of quetiapine together with valproate in patients with acquired brain injury could increase the incidence of medication-induced neutropenia.

Topics: Aged; Anticonvulsants; Antipsychotic Agents; Brain Injuries; Cohort Studies; Delirium; Drug Therapy, Combination; Female; Humans; Incidence; Male; Middle Aged; Neutropenia; Quetiapine Fumarate; Retrospective Studies; Valproic Acid

Our case report addresses the use of clozapine in patients who have a history of quetiapine XR-induced neutropenia. There are no current guidelines for this situation.. We present the case of a young woman treated with clozapine at a first-episode psychosis clinic after a moderate quetiapine XR-induced neutropenia (0,5-1,0 × 10(9)  L(-1) ).. The patient was successfully treated with clozapine and lithium, with less psychotic symptoms and a better level of functioning. The neutrophil count remained normal during the treatment period, which has been longer than a year.. The outcome of this case supports the notion that clinicians could consider introducing clozapine in treatment-refractory patients who have a history of quetiapine XR-induced neutropenia, with close blood monitoring. Lithium co-administration may play a role in maintaining a normal neutrophil count.

Topics: Antipsychotic Agents; Clozapine; Delayed-Action Preparations; Drug Resistance; Female; Humans; Leukocyte Count; Neutropenia; Neutrophils; Quetiapine Fumarate; Schizophrenia; Young Adult

Quetiapine is a dibenzothiazepine derivative, similar to clozapine, which has the highest risk of causing blood dyscrasias, especially neutropenia. There are some case reports about this side effect of quetiapine, but possible risk factors are seldom discussed and identified. A case of a patient with hepatocellular carcinoma that developed neutropenia after treatment with quetiapine is described here.. A 62-year-old Taiwanese widow with bipolar disorder was diagnosed with hepatocellular carcinoma at age 60. She developed leucopenia after being treated with quetiapine. After quetiapine was discontinued, her white blood cell count returned to normal.. Although neutropenia is not a common side effect of quetiapine, physicians should be cautious about its presentation and associated risk factors. Hepatic dysfunction may be one of the possible risk factors, and concomitant fever may be a diagnostic marker for adverse reaction to quetiapine.

Topics: Antipsychotic Agents; Bipolar Disorder; Carcinoma, Hepatocellular; Dibenzothiazepines; Female; Humans; Liver Function Tests; Liver Neoplasms; Middle Aged; Neutropenia; Quetiapine Fumarate; Risk Factors; Taiwan

Clozapine was the first of the atypical antipsychotics to be developed, but its use has been restricted because of toxicity issues, particularly the risk of potentially life-threatening drug-induced neutropenia and agranulocytosis, which occurs in about 1% of patients. Bioactivation of clozapine by peroxidases forms a reactive nitrenium ion, which covalently adducts to protein and leads to neutrophil toxicity. The current generation of clozapine-inspired atypical antipsychotics has reduced toxicity through improved potency/decreased dose or through structural modification to prevent peroxidase-catalyzed nitrenium ion formation. Through the substitution of sulfur for the bridging nitrogen found in clozapine, quetiapine does not directly form a nitrenium ion when incubated with myeloperoxidase/H(2)O(2). We present evidence that cytochrome P450 2D6 catalyzes the formation of 7-hydroxyquetiapine, which can be oxidized by human myeloperoxidase to form a reactive quinone-imine and a reactive radical, which may account for the continued, although reduced, neutrophil toxicity. In the presence of myeloperoxidase/H(2)O(2) and glutathione, covalent 7-hydroxyquetiapine-glutathione adducts were formed. Bioactivation of quetiapine was verified in vivo in rat where three 7-hydroxyquetiapine-mercaptate adducts and a 7-hydroxyquetiapine-glutathione adduct were detected from bile after oral dosing. The decreased incidence of agranulocytosis with quetiapine over clozapine is postulated to be due to the lower exposure of the toxic precursor, 7-hydroxyquetiapine versus clozapine, respectively.

Topics: Agranulocytosis; Animals; Antipsychotic Agents; Clozapine; Cyanides; Cytochrome P-450 CYP2D6; Dibenzothiazepines; Female; Glutathione; Horseradish Peroxidase; Humans; Male; Neutropenia; Peroxidase; Quetiapine Fumarate; Rats; Rats, Sprague-Dawley

A patient's death due to severe hematologic adverse effects of the concomitant use of four psychotropic medications is reported.. A 40-year-old Caucasian woman with a 9-year history of depression and anxiety (managed with alprazolam) was admitted to a psychiatric hospital for the treatment of acute psychotic symptoms. After nine days, the patient was discharged home on a regimen of lamotrigine, mirtazapine, quetiapine, and venlafaxine. Five weeks later, the development of severe ocular cellulitis, severe oral thrush, and febrile neutropenia necessitated the woman's urgent rehospitalization; on admission, her white blood cell count was 600 cells/mm(3), her absolute neutrophil count was 18 cells/mm(3), and microbial pathogens were isolated in peripheral blood and tracheal aspirate cultures. Despite treatment with antibiotics and filgrastim, the patient developed multiorgan dysfunction and died five days later from septic shock. The woman's concomitant use of multiple psychotropics and the late recognition of drug-induced agranulocytosis likely contributed to her severe symptoms and ultimate death. The application of the Naranjo scale to this case yielded a score of 6, indicating a probable adverse drug reaction. Although hematologic adverse effects have been reported with the use of each of the four drugs implicated in the woman's death, this is thought to be the first report of fatal agranulocytosis associated with any of the drugs.. A 40-year old woman with a history of acute psychotic symptoms developed agranulocytosis and neutropenia after starting therapy that included lamotrigine, mirtazapine, quetiapine, and venlafaxine.

Topics: Adult; Agranulocytosis; Antidepressive Agents, Second-Generation; Antimanic Agents; Antipsychotic Agents; Blood Cell Count; Cyclohexanols; Depressive Disorder, Major; Dibenzothiazepines; Fatal Outcome; Female; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Lamotrigine; Mianserin; Mirtazapine; Multiple Organ Failure; Neutropenia; Orbital Cellulitis; Psychotic Disorders; Psychotropic Drugs; Quetiapine Fumarate; Recombinant Proteins; Shock, Septic; Triazines; Venlafaxine Hydrochloride

Topics: Aged, 80 and over; Antimanic Agents; Antipsychotic Agents; Asian People; Bipolar Disorder; Dementia, Vascular; Dibenzothiazepines; Drug Monitoring; Drug Therapy, Combination; Female; Hallucinations; Humans; Male; Middle Aged; Neutropenia; Psychomotor Agitation; Quetiapine Fumarate; Treatment Outcome; Valproic Acid

Topics: Adult; Anti-Anxiety Agents; Antimanic Agents; Antipsychotic Agents; Anxiety Disorders; Bipolar Disorder; Clonazepam; Delayed-Action Preparations; Delusions; Dibenzothiazepines; Drug Monitoring; Drug Therapy, Combination; Humans; Male; Mianserin; Mirtazapine; Neutropenia; Polypharmacy; Quetiapine Fumarate; Suicidal Ideation; Treatment Outcome; Valproic Acid

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

At the Austin State Hospital, Austin, TX, a number of cases of neutropenia and leukopenia have been observed in children and adolescents who were treated with the combination of valproate and quetiapine. Use of this combination has raised concerns regarding an increased risk of hematologic toxicity.. To evaluate the incidence of leukopenia and neutropenia associated with the use of valproate, quetiapine, or the combination in the child and adolescent population.. This study was a retrospective evaluation of patients from the child and adolescent psychiatric service of the Austin State Hospital who were treated with valproate, quetiapine, or the combination. Subjects were selected from patients discharged between August 1, 2004, and August 31, 2007. Laboratory data were evaluated to determine the incidence and severity of leukopenia and neutropenia associated with valproate, quetiapine, and a combination of the 2.. A total of 131 patients were included in the study. Analysis of the laboratory data revealed a combined incidence of neutropenia and/or leukopenia of 44%, 26%, and 6% in the combination group, valproate monotherapy group, and quetiapine monotherapy group, respectively. Differences in the incidence of neutropenia and/or leukopenia between the quetiapine monotherapy group and valproate monotherapy group, as well as the quetiapine monotherapy group and the combination group reached statistical significance. A significant difference was found among groups based on absolute neutrophil count Common Toxicity Criteria severity (p < 0.001). The combination group differed significantly in incidence of moderate-to-severe neutropenia (14 cases) from both the valproate (5 cases) and quetiapine (0 cases) monotherapy groups. A significantly greater number (44%) of African American patients experienced neutropenia and/or leukopenia than white (not Hispanic or Latino; 29%) or Hispanic or Latino (11%) patients.. Patients treated with valproate or the combination of valproate and quetiapine should be monitored for the occurrence of leukopenia and neutropenia. Controlled studies are warranted to examine possible pharmacokinetic and pharmacodynamic interactions with the combination of valproate and quetiapine to further evaluate the hematologic findings of this study.

Topics: Adolescent; Anticonvulsants; Child; Dibenzothiazepines; Drug Therapy, Combination; Female; Hospitalization; Humans; Incidence; Leukopenia; Male; Neutropenia; Quetiapine Fumarate; Retrospective Studies; Severity of Illness Index; Valproic Acid

Leucopenia and neutropenia could be side effects of anti-psychotic drugs, especially clozapine. However, there is evidence that other anti-psychotics can cause leucopenia and neutropenia. We present the clinical follow-up and treatment process of a patient, who had initially developed quetiapine and amisulpride related neutropenia, but not with aripiprazole.

Topics: Adult; Amisulpride; Antipsychotic Agents; Aripiprazole; Blood Cell Count; Dibenzothiazepines; Female; Humans; Leukopenia; Neutropenia; Piperazines; Psychotic Disorders; Quetiapine Fumarate; Quinolones; Sulpiride

Leukopenia and neutropenia are recognised as side effects of antipsychotic medication, notably clozapine. A case is presented in which a female Caucasian patient who had previously developed these side effects with clozapine also developed them with quetiapine in conjunction with semisodium valproate. There was no such reaction to zuclopenthixol, sulpiride, olanzapine and aripiprazole. It is concluded that caution should be exercised when treating with quetiapine especially where there has been neutropenia with a previous antipsychotic agent.

Topics: Adult; Antimanic Agents; Antipsychotic Agents; Dibenzothiazepines; Drug Resistance; Female; Humans; Leukopenia; Neutropenia; Quetiapine Fumarate; Recurrence; Schizophrenia; Valproic Acid

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Neutropenia; Quetiapine Fumarate; Schizophrenia