Clozapine re-challenge in patients with history of blood dyscrasia 3 Year follow up
Abstract
Clozapine re-challenge in an individual with a history of clozapine-induced blood dyscrasia is not often attempted. However it can be considered in patients with history of good response to the drug in the past, and where the risk of re-challenge is considered to be less than the risk of withholding treatment. Increasing the frequency of monitoring of white blood counts and the use of lithium or Granulocyte-Colony Stimulating Factors are the strategies that have been reported to be helpful during re-challenge. A dyscrasia that occurs during rechallenge is reported to be earlier in onset and longer lasting. We report the three year follow up data of two patients who had a blood dyscrasia following which they were re-challenged with clozapine.
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Taylor DM, Duncan-McConnell D. Refractory schizophrenia and atypical antipsychotics. J Psychopharmacol Oxf Engl. 2000;14(4):409–18.
Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am J Psychiatry. 1995 Feb;152(2):183–90.
Solanki R, Singh P, Swami M. Clozapine: Current perspective. Indian J Psychiatry. 2007;49(4):271.
Atkin K, Kendall F, Gould D, Freeman H, Liberman J, O’Sullivan D. Neutropenia and agranulocytosis in patients receiving clozapine in the UK and Ireland. Br J Psychiatry J Ment Sci. 1996 Oct;169(4):483–8.
Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988;45(9):789–96.
Dunk LR, Annan LJ, Andrews CD. Rechallenge with clozapine following leucopenia or neutropenia during previous therapy. Br J Psychiatry. 2006 Mar 1;188(3):255–63.
Manu P, Sarpal D, Muir O, Kane JM, Correll CU. When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature. Schizophr Res. 2012 Feb;134(2-3):180–6.
Lertxundi U, Sanchez P, Hernandez R, Elizagarate E. A case of agranulocytosis secondary to rechallenge with clozapine following severe neutropenia during previous therapy. J Clin Psychiatry. 2011 Dec;72(12):1659.
Hägg S, Rosenius S, Spigset O. Long-term combination treatment with clozapine and filgrastim in patients with clozapine-induced agranulocytosis. Int Clin Psychopharmacol. 2003 May;18(3):173–4.
Kanaan RA, Kerwin RW. Lithium and Clozapine Rechallenge: A Retrospective Case Analysis. J Clin Psychiatry. 2006 May 15;67(5):756–60.
Gerson SL. G-CSF and the management of clozapine-induced agranulocytosis. J Clin Psychiatry. 1994 Sep;55 Suppl B:139–42.
Mukherjee A, Russell PS. Clozapine rechallenge in a patient with clozapine induced leucopenia. Med Ej [Internet]. [cited 2016 Feb 7];5(January - February 2015). Available from: http://medej.tnmgrmu.ac.in/ArticleViewer.aspx?id=3996
Gopalakrishnan R, Subhalakshmi T, Kuruvilla A, Jacob K. Clozapine re-challenge under the cover of Filgrastim. J Postgrad Med. 2013 Mar;59(1):54–5.
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