Columbus, Ohio TO THE EDITOR: Although clozapine is considered the most effective antipsychotic for treatment-resistant schizophrenia, it is underutilized because of the risk of clozapine-induced agranulocytosis and neutropenia. While drug interactions, benign ethnic neutropenia, and medical comorbidity can often contribute to clozapine-induced agranulocytosis, most patients who develop neutropenia or agranulocytosis do not restart clozapine after its discontinuation. While treating a patient with a history of robust response to discontinued clozapine, we incorporated a newly available genetic test to help with the decision to attempt a clozapine rechallenge.Case Report A 33-year-old Caucasian woman with treatment-resistant schizoaffective disorder developed neutropenia after 8 years of clozapine treatment. The patient had achieved relative stability while taking quetiapine, 400 mg/day; extended-release divalproex, 1500 mg/day; and clozapine, 300 mg/day. After discontinuing clozapine because of neutropenia that was discovered after routine testing (absolute neutrophil count, 600 cells/mm3; WBC, 2,800 cells/mm3), she experienced worsening psychosis and catatonic symptoms that led to hospitalization. During the hospitalization, the hematology consultant opined that her low absolute neutrophil count was due to clozapine therapy, so clozapine was not restarted. Over the next 5 months, the patient did not respond to pharmacologic treatments or ECT. Because of the patient's previous positive
Clozapine Rechallenge After Excluding the High-Risk Clozapine-Induced Agranulocytosis Genotype of HLA-DQB1 6672G>C
Abstract
Columbus, Ohio TO THE EDITOR: Although clozapine is considered the most effective antipsychotic for treatment-resistant schizophrenia, it is underutilized because of the risk of clozapine-induced agranulocytosis and neutropenia. While drug interactions, benign ethnic neutropenia, and medical comorbidity can often contribute to clozapine-induced agranulocytosis, most patients who develop neutropenia or agranulocytosis do not restart clozapine after its discontinuation. While treating a patient with a history of robust response to discontinued clozapine, we incorporated a newly available genetic test to help with the decision to attempt a clozapine rechallenge.Case Report A 33-year-old Caucasian woman with treatment-resistant schizoaffective disorder developed neutropenia after 8 years of clozapine treatment. The patient had achieved relative stability while taking quetiapine, 400 mg/day; extended-release divalproex, 1500 mg/day; and clozapine, 300 mg/day. After discontinuing clozapine because of neutropenia that was discovered after routine testing (absolute neutrophil count, 600 cells/mm3; WBC, 2,800 cells/mm3), she experienced worsening psychosis and catatonic symptoms that led to hospitalization. During the hospitalization, the hematology consultant opined that her low absolute neutrophil count was due to clozapine therapy, so clozapine was not restarted. Over the next 5 months, the patient did not respond to pharmacologic treatments or ECT. Because of the patient's previous positive
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Clozapine Rechallenge After Excluding the High-Risk Clozapine-Induced Agranulocytosis Genotype of HLA-DQB1 6672G>C
McKnight, Curtis; Guirgis, Hossam; Votolato, Nick
Follow American Journal of Psychiatry
, Volume 168 (10): 1120
American Psychiatric Publishing, Inc (Journal) – Oct 1, 2011
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