Need to bleed? Clozapine haematological monitoring approaches a time for change.

  title={Need to bleed? Clozapine haematological monitoring approaches a time for change.},
  author={Eromona Whiskey and Olubanke Dzahini and Rosalind Ramsay and David O'flynn and Aleksandar Mijovic and Fiona Gaughran and James Hunter MacCabe and Sukhi S. Shergill and David Taylor},
  journal={International Clinical Psychopharmacology},
Regular haematological monitoring during clozapine treatment reduces the risk of complications and death from clozapine-related blood dyscrasias. However, many patients in the course of clozapine treatment develop neutropenia unrelated to drug treatment which leads to treatment discontinuation. The minimum haematological threshold allowed for the continuation of clozapine treatment was recently lowered in the US, but not in the UK. In this case series, we present four cases where lowering the… 

Clozapine rechallenge and initiation despite neutropenia- a practical, step-by-step guide

Having had involvement with 14 cases of clozapine use in these circumstances, the approach to the assessment of risks and benefits, risk mitigation and monitoring with a practical guide is set out.

There Is Life After the UK Clozapine Central Non-Rechallenge Database.

Implementation of the updated FDA's monitoring criteria in the United Kingdom would significantly reduce clozapine discontinuation due to hematological reasons and suggest an urgent need for revising the UK clozAPine monitoring guidelines to improve outcomes in treatment-resistant schizophrenia.

Resolution without discontinuation: heart failure during clozapine treatment

The case of a 51-year-old man with treatment-resistant schizoaffective disorder, who was admitted to a locked rehabilitation unit for a clozapine rechallenge, and was diagnosed with heart failure likely secondary to his antipsychotic treatment, is presented.

Distinctive pattern of neutrophil count change in clozapine-associated, life-threatening agranulocytosis

It is concluded that an important proportion of cases of agranulocytosis identified in people prescribed clozapine are not life-threatening and may not even be clozAPine-related.

An evaluation of the variation and underuse of clozapine in the United Kingdom

Clozapine is the only licensed treatment for treatment refractory schizophrenia. Despite this, it remains grossly underused relative to the prevalence of refractory schizophrenia. The extent of

Benign ethnic neutropenia: an analysis of prevalence, timing and identification accuracy in two large inner-city NHS hospitals

Current evidence suggests that BEN remains an uncommonly recognised haematological phenotype, and adoption of current FDA BEN monitoring criteria in the UK may further reduce clozapine discontinuation due to perceived neutropenia as drug toxicity, particularly in treatment-refractory schizophrenia patients.

S204579602200066Xjra 1..10

  • 2022

Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital

Even in this extreme group of patients with treatment resistant schizophrenia, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients, according to a case series of 14 consecutive patients rechallenged in a high-secure psychiatric hospital.

Effect of age on the relative efficacy of clozapine in schizophrenia

This systematic review and meta‐analysis aims to assess clozapine’s superiority over alternative antipsychotic medication and examine whether earlier use is associated with additional benefit.



Changes for clozapine monitoring in the United States

Lithium and granulocyte-colony stimulating factor have been used as preventative therapies for patients with a history of clozapineinduced neutropenia upon clozAPine re-challenge.

Continuing clozapine with granulocyte colony-stimulating factor in patients with neutropenia

The treatment and progress of a number of patients in a secure psychiatric hospital in the UK were described, it is hoped that this case series will raise the profile of a potentially effective alternative to discontinuing clozapine after neutropenia.

Neutropenia and Agranulocytosis in Patients Receiving Clozapine in the UK and Ireland

The use of a patient monitoring service kept the haematological risks associated with using clozapine within acceptable limits, particularly in view of the benefits of this medication in treatment-resistant schizophrenia.

Managing clozapine-induced neutropenia with lithium

The efficacy and safety of lithium augmentation for the management of clozapine-induced neutropenia is reviewed and it is found that 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 clozapsania, thus allowing more patients to benefit from treatment withClozapines.

Restarting Clozapine after Neutropenia

Uncertainty over the likely cause of blood dyscrasia in people taking clozapine, coupled with uncertainty over the mechanism by which clozabine causes both neutropenia and agranulocytosis, makes any attempt to restart clozAPine a high-risk venture requiring the utmost caution.

The importance of the recognition of benign ethnic neutropenia in black patients during treatment with clozapine: case reports and database study

To optimize clozapine treatment and improve long-term outcomes, a significantly greater proportion of Black patients should be registered as having Benign Ethnic Neutropenia.

Clozapine-induced transient white blood count disorders.

BACKGROUND The aim of the study was to shed more light on the incidence and course of clozapine-induced transient white blood count (WBC) disorders. METHOD In an analysis of our clozapine drug

Neutropenia and agranulocytosis during treatment of schizophrenia with clozapine versus other antipsychotics: an observational study in Iceland

Neutropenia is common both in patients with schizophrenia on clozapine treatment and in those never on clazapine, and these findings have implications in assessing the balance between the risk of progression from neutropania to agranulocytosis against the morbidity resulting from the premature discontinuation of clozAPine under the current monitoring regulations in the US and in most of Europe.

Clozapine-induced agranulocytosis

A patient with severe schizophrenia who received several different antipsychotic, antidepressant and anxiolytic drugs without hematological side effects and upon challenge with clozapine developed severe pure~white cell aplasia is described.

Clozapine-induced agranulocytosis. Incidence and risk factors in the United States.

The increasing risk of agranulocytosis with age and the reduced incidence after the first six months of treatment provide additional guidelines for the prescription and monitoring of clozapine treatment in the future.