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Current Drug Safety

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ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

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Case Report

Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

Author(s): Asma H. Almaghrebi *

Volume 14, Issue 1, 2019

Page: [80 - 83] Pages: 4

DOI: 10.2174/1574886313666180807094654

Price: $65

Abstract

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia.

Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue.

Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 × 109 L, and her neutrophils decreased to 0.1 × 109 L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol).

Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

Keywords: Clozapine, quetiapine, leukopenia, neutropenia, agranulocytosis, schizophrenia.

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[1]
Stephen SS. Essential psychopharmachology. 4th ed. New York, United States of America: New York: Cambridge University Press 2013.
[2]
Correll CU, Kane JM. The role of clozapine in treatment-resistant schizophrenia. JAMA Psychiatry 2016; 73(3): 187-9.
[3]
Kisely S, Siskind D, Siskind V. Clozapine response rates among people with treatment-resistant schizophrenia: Data from a systematic review and meta-analysis. Can J Psychiatry 2017; 62(11): 772-7.
[4]
Dickens G, Frogley C, Picchioni M, Taylor D. A systematic review of the evidence of clozapine’s anti-aggressive effects. Int J Neuropsychopharmacol 2012; 15(9): 1351-71.
[5]
Alphs L, Altamura C, Anand R, et al. Clozapine treatment for suicidality in schizophrenia. Arch Gen Psychiatry 2003; 60(7): 735.
[6]
Dold M, Gianatsi M, Helfer B, et al. Efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia: A network meta-analysis. JAMA Psychiatry 2016; 73(3): 199-210.
[7]
Carvalhoand F, Flanagan R, Nooijen P. Haematological toxicity of clozapine and some other drugs used in psychiatry. Hum Psychopharmacol Clin 2011; 26: 112-9.
[8]
Bandelow B, Engel R, Grohmann R, Ludwig WD, Stübner S, Wagner G. Blood dyscrasias induced by psychotropic drugs. Pharmacopsychiatry 2004; 37: 70-8.
[9]
Cohen D, Bogers J, Van Dijk D, Bakker B, Schulte P. Beyond white blood cell monitoring: screening in the initial phase of clozapine therapy. J Clin Psychiatry 2012; 73(10): 1307-12.
[10]
Dunk L, Flanagan R. Haematological toxicity of drugs used in psychiatry. Hum Psychopharmacol Clin 2008; 23: 27-41.
[11]
DelBello M, Earley WR, Findling RL, Liu S, Pathak S. Safety, tolerability, and efficacy of quetiapine in youth with schizophrenia or bipolar I disorder: A 26-week, open-label, continuation study. J Child Adolesc Psychopharmacol 2013; 23(7): 490-501.
[12]
Seroquel 25 mg, 100 mg, 200 mg and 300 mg film-coated tablets. From the electronic Medicines Compendium (eMC); Available from: https://www.medicines.org.uk/emc/product/5495/smpc
[13]
Becker HE, Heeringa M, Jessurun P, Marees CH, Ruhé HG, Vermeulen HDB. Agranulocytosis and granulocytopenia associated with quetiapine. Acta Psychiatr Scand 2001; 104(4): 311-3.
[14]
Andrews CD, Annan LJ, Dunk LR. Rechallenge with clozapine following leucopenia or neutropenia during previous therapy. Br J Psychiatry 2006; 188: 255-63.
[15]
Cameron MD, Li X. Potential role of a quetiapine metabolite in quetiapine-induced neutropenia and agranulocytosis. Chem Res Toxicol 2012; 25(5): 1004-11.
[16]
Crépeau-Gendron G, L’Heureux S. Quetiapine XR-induced neutropenia: Is a clozapine trial still possible for treatment-resistant schizophrenia? A case report. Early Interv Psychiatry 2015; 9(2): 151-5.
[17]
Cowan C, Oakley C. Leukopenia and neutropenia induced by quetiapine. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31(1): 292-4.
[18]
Arellano F, Bianchini A, Honigfeld G, Schein J, Sethi J. Reducing clozapine-related morbidity and mortality: 5 years of experience with the clozaril national registry. J Clin Psychiatry 1998; 59: 307.
[19]
Croarkin P, Rayner T. Acute neutropenia in a patient treated with quetiapine. Psychosomatics 2001; 41(4): 368.
[20]
Dettling M, Hahn E, Herzog I, et al. Clozapine-induced agranulocytosis: Evidence for an immune-mediated mechanism from a patient-specific in-vitro approach. Toxicol Appl Pharmacol 2017; 316: 10-6.
[21]
Alvir J, Lieberman J, Safferman A, Schaaf J, Schwimmer J. Clozapine-induced a granulocytosis: Incidence and risk factors in the United States. N Engl J Med 1993; 329: 162-7.
[22]
Barak Y, Kutzuk D, Naor S, Weizman A, Wittenberg N. Clozapine in elderly psychiatric patients: Tolerability, safety, and efficacy. Compr Psychiatry 1999; 40(4): 320-5.
[23]
de With SAJ, Kahn RS, Ophoff RA, Pulit SL, Staal WG. More than 25 years of genetic studies of clozapine-induced agranulocytosis. Pharmacogenomics J 2017; 17: 304.
[24]
Lewis CM, Verbelen M. How close are we to a pharmacogenomic test for clozapine-induced agranulocytosis? Pharmacogenomics 2015; 16: 915-7.
[25]
Alfirevic A, Duncan L, Fourches D, et al. Clozapine-induced agranulocytosis is associated with rare HLA-DQB1 and HLA-B alleles. Nat Commun 2014; 5: 4757.
[26]
Chowdhury N, Kennedy J, Remington G. Genetics of antipsychotic-induced side effects and agranulocytosis. Curr Psychiatry Rep 2011; 13(2): 156.

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