Clozapine-induced neutropenia in children: management with lithium carbonate.

Clozapine, an atypical antipsychotic, is the most effective medication for treatment-resistant schizophrenia, but its use is limited by the high risk of neutropenia and agranulocytosis. In children, the rate of clozapine-induced neutropenia is even higher than in adults. We report two cases of children 7- and 12-years old diagnosed with very early onset schizophrenia, who developed neutropenia when treated with clozapine. In both cases addition of lithium carbonate elevated the white blood count (WBC) allowing clozapine rechallenge. WBC and total neutrophil count remained stable long-term with coadministration of clozapine (400-425 mg per day) and lithium with the blood level of 0.8-1.1 microg/mL. This report supports the use of adjunct lithium for clozapine-induced neutropenia as a safe and successful strategy in children.

[1]  F. Limosin,et al.  Continuing clozapine treatment despite neutropenia , 2004, European Journal of Clinical Pharmacology.

[2]  T. Manschreck,et al.  Initiation of Clozapine Therapy in a Patient with Preexisting Leukopenia: A Discussion of the Rationale of Current Treatment Options , 2001, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[3]  H. Remschmidt,et al.  Management of Schizophrenia in Children and Adolescents , 2000 .

[4]  J. Rapoport,et al.  Retreatment with clozapine after erythromycin-induced neutropenia. , 2000, The American journal of psychiatry.

[5]  R. Kerwin,et al.  Active monitoring of 12760 clozapine recipients in the UK and Ireland , 1999, British Journal of Psychiatry.

[6]  E. Elonen,et al.  Circadian rhythm of white blood cells during clozapine treatment , 1999, Psychopharmacology.

[7]  C. Advokat,et al.  Clinical outcome to clozapine treatment in chronic psychiatric inpatients , 1999, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[8]  P. Blier,et al.  Lithium and clozapine-induced neutropenia/agranulocytosis. , 1998, International clinical psychopharmacology.

[9]  P. Silverstone.  Prevention of clozapine-induced neutropenia by pretreatment with lithium. , 1998, Journal of clinical psychopharmacology.

[10]  W. Fleischhacker,et al.  Treatment of severe clozapine-induced neutropenia with granulocyte colony-stimulating factor (G-CSF) , 1998, British Journal of Psychiatry.

[11]  J. Lieberman,et al.  Maximizing clozapine therapy: managing side effects. , 1998, The Journal of clinical psychiatry.

[12]  A. Zametkin,et al.  The neurobiology of attention-deficit/hyperactivity disorder. , 1998, The Journal of clinical psychiatry.

[13]  H. Meltzer.  Suicide in schizophrenia: risk factors and clozapine treatment. , 1998, The Journal of clinical psychiatry.

[14]  J. Rapoport,et al.  Childhood-onset schizophrenia: A double-blind clozapine-haloperidol comparison , 1996 .

[15]  R. Baker,et al.  The treatment of clozapine-associated agranulocytosis with granulocyte colony-stimulating factor (G-CSF). , 1996, Psychopharmacology bulletin.

[16]  Adityanjee.  Modification of clozapine-induced leukopenia and neutropenia with lithium carbonate. , 1995, The American journal of psychiatry.

[17]  J. Lieberman,et al.  Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. , 1993, The New England journal of medicine.

[18]  Abraham Weizman,et al.  Clozapine-lithium combined treatment and agranulocytosis. , 1993, International clinical psychopharmacology.

[19]  K. Havemann,et al.  SUCCESSFUL TREATMENT OF CLOZAPINE INDUCED AGRANULOCYTOSIS WITH GRANULOCYTE‐COLONY STIMULATING FACTOR (G‐CSF) , 1992, British journal of haematology.