Клозапин, нейтропения и гранулоцитарный фактор, стимулирующий рост клеток

Clozapine is the treatment of choice for treatment-resistant schizophrenia, but it is associated with a risk of neutropaenia and agranulocytosis. Clozapine use is regulated by mandatory blood monitoring in the UK, requiring cessation of treatment should the absolute neutrophil count (ANC) drop below specified values. Benign reductions in the ANC in non-white populations are common, and this can preclude a patient from receiving treatment with clozapine. A diagnosis of benign ethnic neutropaenia can reduce these treatment restrictions (UK specific), but the degree of neutropaenia can be significant enough to still prevent treatment. In this report, we show that response to granulocyte colony stimulating factor (G-CSF) may be quite variable and difficult to predict, but with careful monitoring it can be used to increase the ANC count and allow continued treatment with clozapine.

 Granulocyte Colony Stimulating Factor (G-CSF) can allow treatment with clozapine in a patient with severe Benign Ethnic Neutropaenia (BEN): a case report

Успешное возобновление клозапина у пациентки с нейтропенией вызванной клозапином

S.P. was a 56-year-old African American man with a 30-year history of paranoid schizophrenia. He had sufficiently tolerated a clozapine rechallenge in 2007, 2 years after developing clozapine-induced neutropenia. Following a period of relative stability after the rechallenge, he discontinued treatment with clozapine because of complaints of dizziness and an unwitnessed syncopal episode, which were not clearly attributed to the drug. Shortly afterward, he suffered functional decline and required inpatient stabilization. He was initially titrated to haloperidol (20 mg/twice daily), olanzapine (20 mg/day), and divalproex sodium (750 mg/twice daily). Unfortunately, this regimen was ineffective, and he continued to exhibit bizarre behavior, severe paranoid delusions, social isolation, and an inability to conduct activities of daily living. In light of his improvement after the 2007 clozapine rechallenge, S.P. and his treatment team elected to initiate clozapine treatment again.

Clozapine Rechallenge in Refractory Schizophrenia