CLOZAPINE RECHALLENGE WITH LITHIUM AFTER DOUBLE INDUCED NEUTROPENIA: A CASE REPORT

Abstract

Clozapine is a second generation antipsychotic drug, which has been acknowledged as the gold standard for treating both positive and negative symptoms of treatment-resistant schizophrenic patients, despite its severe side effects, such as neutropenia. Evidence suggest rechallenging after clozapine-induced neutropenia. Nevertheless, no official guidelines exist in case that rechallenge fails. We present the case of a fifty-six year old man suffering from treatment resistant schizophrenia. The patient was diagnosed with chronic psychosis and was treated with clozapine, presenting good response. The patient developed clozapine induced neutropenia, only to be rechallenged after the neutrophil count returned at a normal range. However, another neutropenia incidence followed, and clozapine had to be ceased once more. Determining that the benefits outweighed risks, we attempted a second rechallenge with the adjustment of clozapine’s dosage and the addition of Lithium carbonate. Since then, the patient did not develop any blood dyscrasia. What is more, the improvement in both psychopathology and functionality is ongoing. The mechanism of clozapine’s action upon neutrophils remains unclear. The same goes for Lithium. Since literature suggests that both drugs have an effect on the bone marrow, resulting in opposite actions it only seems logical that Lithium could be used in preventing clozapine-induced neutropenia. Considering that the lack of guidelines leads to a restrain towards clozapine rechallenge after neutropenia incidence, more so after double induced neutropenia, more research is needed on the matter in the interest of a better quality of life for treatment resistant schizophrenia patients.