Neutropenia Induced by Second Generation Antipsychotics: A Prospective Investigation
Medical University Innsbruck, Department of Psychiatry, Innsbruck, Austria. Pharmacopsychiatry
(Impact Factor: 1.85).
02/2010; 43(2):41-4. DOI: 10.1055/s-0030-1249071
Clozapine is known to induce neutropenia as well as agranulocytosis. Some cases of olanzapine- and risperidone-induced neutropenia and agranulocytosis have also been reported. We prospectively investigated schizophrenia patients treated with second generation antipsychotics with respect to alterations of white blood cell counts.
In an analysis of our drug monitoring program, we studied white blood cell counts in 104 patients receiving different second generation antipsychotics other than clozapine for at least six months and compared them with those of 28 patients receiving clozapine.
We found neutropenia (neutrophils <2 000/microL) in the mixed group in 17.6% and in 11.8% of patients treated with clozapine during the first 6 months. There was no statistically significant difference between those groups with respect to the risk to develop neutropenia during the investigation period. There was no case of agranulocytosis. Neutropenia was transient in all patients. Eosinophilia occurred in some patients that developed neutropenia later on but had no significant predictive value.
Available from: Gianluca Trifirò
- "Agranulocytosis, a severe neutropenia that may increase the risk of infections, is a well-known adverse drug reaction of clozapine, even though it occurs in less than 1% of treated patients. Recent evidence suggests that all the other atypical antipsychotics and some typical antipsychotics can induce neutropenia but, in contrast to clozapine, this neutropenia very rarely progresses to agranulocytosis . In a US cohort of 11,555 clozapine users in whom a weekly white-cell count was required to receive a supply of the drug, most of the cases of agranulocytosis occurred within the first 3 months of the treatment . "
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ABSTRACT: Antipsychotics are generally distinguished as atypical and typical agents, which are indicated in the treatment of acute and chronic psychoses and other psychiatric disorders. In April 2005, the US Food and Drug Administration issued a warning about the increased risk of all-cause mortality associated with atypical antipsychotic use in elderly patients with dementia. Pneumonia was one of the most frequently reported causes of death. The same warning was extended to typical antipsychotics in June 2008. In recent years, several observational studies have further explored the association between antipsychotic use, mainly in elderly patients, and the risk of fatal/nonfatal community-acquired pneumonia. The aim of this review is to revise and discuss the scientific evidence and biologic explanations for the association between atypical and typical antipsychotic use and pneumonia occurrence. Some general recommendations to clinicians are proposed to prevent the risk of pneumonia in patients requiring antipsychotic treatment.
Available from: R. E Kast
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