Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review.

Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review. Clin Schizophr Relat Psychoses. 2018 Jun 26;: Authors: Boazak M, Kahn B, Cox L, Ragazino J, Goldsmith DR, Cotes RO Abstract Clozapine-induced neutropenia occurs in 3-5% of individuals treated with clozapine. Current US guidelines require interruption of clozapine when the absolute neutrophil count (ANC) drops below 1000 cells/mm3. There is minimal available guidance for what dosing schedule to use when restarting clozapine after an episode of neutropenia. Here, we present a case of a 50-year-old Caucasian female with a history of schizoaffective disorder who was successfully rechallenged on clozapine one month after developing clozapine-induced neutropenia (ANC 600 cells/mm3). To understand published re-titration rates of clozapine after neutropenia, we conducted a literature review using a using the PubMed database and found only seven case reports that unambiguously reported a clozapine dosing schedule during re-challenge. All were successful except one, a case of clozapine rechallenge after agranulocytosis. Including this case presentation, six out of eight cases restarted clozapine more cautiously than recommended by the US guidelines for a new clozapine initiation. We cannot comment what role a slower or more rapid titration plays in a successful rechallenge after neutropenia with the available evidence. We encourage r...
Source: Clinical Schizophrenia and Related Psychoses - Category: Psychiatry Tags: Clin Schizophr Relat Psychoses Source Type: research