Severe neutropenia occurs in a small percentage of patients taking clozapine.The absolute neutrophil count (ANC) is now to be used exclusively, instead of the white blood cell (WBC) count, in monitoring patients for drug-induced neutropenia. Your Email: <>
Clozapine and blood dyscrasias in patients with coronavirus (COVID-19) Coronavirus infection may depress lymphocyte count but does not reduce neutrophils Effect of COVID-19 on WCC Current data suggest that COVID-19 infection results in a lowered white cell count (WCC) for some (9–45% of patients have WCC <4.0 x 109/L) (1–5).
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However, WBC monitoring after the first 6 months of clozapine treatment is not evidence-based because the incidence of agranulocytosis does not exceed that of conventional antipsychotics, for which no such requirement exists. DSM-5® Handbook on the Cultural Formulation InterviewThe Journal of Neuropsychiatry and Clinical NeurosciencesIdänpään-Heikkilä J, Alhava E, Olkinuora M, Palva IClozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazineRisk of clozapine-associated agranulocytosis and mandatory white blood cell monitoringClozapine-induced agranulocytosis after 11 years of treatmentLate-onset agranulocytosis in a patient with schizophrenia after 17 months of clozapine treatmentAgranulocytosis after addition of risperidone to clozapine treatmentRaveendranathan D, Sharma E, Venkatasubramanian G, Rao MG, Varambally S, Gangadhar BNClozapine treatment in Denmark: concomitant psychotropic medication and hematologic monitoring in a system with liberal usage practicesRechallenge of late-onset neutropenia with clozapine[Neutropenia in a patient treated with clozapine in combination with other psychotropic drugs]Sudden late onset of clozapine-induced agranulocytosisLate-onset agranulocytosis in a patient treated with clozapine and lamotrigineKutscher EC, Robbins GP, Kennedy WK, Zebb K, Stanley M, Carnahan RMClozapine-induced leukopenia successfully treated with lithiumClozapine-related agranulocytosis associated with fever of unknown origin, protective hospitalisation, and multiple adverse events related to the administration of empiric antimicrobial treatmentCombined clozapine and valproic acid treatment-induced agranulocytosisIncreased risk of neutropaenia and agranulocytosis with sodium valproate used adjunctively with clozapineConcurrent use of clozapine and valproate in affective and psychotic disordersRatanajamit C, Musakopas C, Vasiknanonte S, Reanmongkol WIncidence and risk for neutropenia/agranulocytosis among clozapine users: a retrospective studyLong-term patient monitoring for clozapine-induced agranulocytosis and neutropenia in Korea: when is it safe to discontinue CPMS?Schulte PF, Cohen D, Bogers JPAM, van Dijk D, Bakker B
Late-onset agranulocytosis is rare during treatment with clozapine, especially in monotherapy. This new program governs all prescribing, dispensing, use, and monitoring of clozapine. Our patient developed agranulocytosis after 19 years of clozapine monotherapy; no concomitant medication was involved, and after discontinuation of clozapine, the patient’s WBC count recovered within a week.Prolonged (>6 months) treatment with clozapine has not been found to carry a greater risk of neutropenia than does treatment with conventional antipsychotics (We thus have a paradox: timely detection of agranulocytosis, the result of the requirement for lifelong WBC counts in clozapine therapy, probably saved this patient’s life.
A week after the discontinuation of clozapine, the patient’s WBC count increased to 3.5×10 9 /L, and 3 weeks later to 4.7×10 9 /L. Clozapine requires differential white blood cell monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly as part of the clozapine patient monitoring service. Lorazepam (2.5 mg) was used occasionally for the treatment of anxiety.Before the initiation of clozapine, Mr. L’s WBC count was 4.2×10We searched PubMed for studies published between January 1980 and September 2012, using the following terms: clozapine, late onset, agranulocytosis. Clipboard, Search History, and several other advanced features are temporarily unavailable. Responsibility for the development and implementation of the Clozapine REMS Program is to be shared by all manufacturers of the drug and covers all clozapine products. Message:
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