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Managing clozapine-induced neutropenia with lithium

Oxleas NHS Trust, Pinewood House, Pinewood Place, Dartford, Kent DA2 7WG (e-mail: Carol.Paton{at}oxleas.nhs.uk)

Raadiyya Esop, Senior Clinical Pharmacist

Oxleas NHS Trust, Dartford, Kent

Declaration of interest

None.

Abstract

AIMS AND METHOD

To review the efficacy and safety of lithium augmentation for the management of clozapine-induced neutropenia. Medline search January 1966 to March 2004.

RESULTS

The ability of lithium to increase the white cell count (WBC) is well documented. A small number of published case reports of the successful treatment of clozapine-induced neutropenia with lithium were identified. Lithium does not protect against agranulocytosis.

CLINICAL IMPLICATIONS

Lithium may be useful in raising the WBC in patients whose baseline count is too low to allow treatment with clozapine to start and to protect against clozapine-induced neutropenia, thus allowing more patients to benefit from treatment with clozapine. It does not protect against agranulocytosis. There is no way of identifying patients whose neutropenia will progress to agranulocytosis. Careful monitoring is essential. Lithium is not licensed to increase WBC. Psychiatrists should be aware of the medicolegal implications of prescribing off-label.

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				S. Ghaznavi, M. Nakic, P. Rao, J. Hu, J. A. Brewer, J. Hannestad, and Z. Bhagwagar Rechallenging With Clozapine Following Neutropenia: Treatment Options for Refractory Schizophrenia Am J Psychiatry, July 1, 2008; 165(7): 813 - 818. [Full Text] [PDF]