Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Oct 13;15(10):e247734.
doi: 10.1136/bcr-2021-247734.

Combination of strategies to initiate clozapine for refractory schizophrenia in a patient with low neutrophil levels

Keisuke Takanobu  1 , Naoki Hashimoto  2 , Shuhei Ishikawa  3 , Ichiro Kusumi  3
Affiliations
Case Reports

Combination of strategies to initiate clozapine for refractory schizophrenia in a patient with low neutrophil levels

Keisuke Takanobu et al. BMJ Case Rep. .

Abstract

Clozapine is the only drug with confirmed efficacy for refractory schizophrenia; however, its use is restricted due to the risk of potentially life-threatening side effects, such as agranulocytosis. Although this restriction ensures safety against haematological risks, some patients with refractory schizophrenia who have low neutrophil levels may miss the opportunity to receive clozapine treatment. We herein report the case of a patient with refractory schizophrenia and low neutrophil levels who was successfully initiated on clozapine treatment after the use of several methods for increasing neutrophil levels. These strategies consisted of discontinuation of antipsychotics, treatment with lithium carbonate and adenine, and light exercise before blood testing. Combining these procedures may be an effective option in the treatment of patients with refractory schizophrenia whose neutrophil levels are not sufficient to initiate clozapine.

Keywords: Drugs: psychiatry; Haematology (incl blood transfusion); Psychiatry (drugs and medicines); Schizophrenia.

PubMed Disclaimer

Conflict of interest statement

Competing interests: KT received personal fees from Otsuka Pharmaceutical and Tsumura. NH received personal fees from Janssen Pharmaceutical, Yoshitomiyakuhin, Otsuka Pharmaceutical, Dainippon Sumitomo Pharma, Novartis Pharma and MeijiSeika Pharma. SI received personal fees from Janssen Pharmaceutical, Dainippon Sumitomo Pharma, Eisai and MeijiSeika Pharma, and received research/grant support from Eli Lilly. IK has received honoraria from Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Lundbeck, Meiji Seika Pharma, Mochida Pharmaceutical, MSD, Mylan, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Shionogi, Shire, Taisho Toyama Pharmaceutical, Takeda Pharmaceutical, Tsumura and Yoshitomiyakuhin, and has received research/grant support from Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Mochida Pharmaceutical, Novartis Pharma, Otsuka Pharmaceutical, Pfizer, Shionogi, Takeda Pharmaceutical and Tanabe Mitsubishi Pharma.

Figures

Figure 1
Figure 1
Neutrophil counts and treatment course over time.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Myles N, Myles H, Xia S, et al. . Meta-Analysis examining the epidemiology of clozapine-associated neutropenia. Acta Psychiatr Scand 2018;138:101–9. 10.1111/acps.12898 - DOI - PubMed
    1. Munro J, O'Sullivan D, Andrews C, et al. . Active monitoring of 12,760 clozapine recipients in the UK and Ireland. beyond pharmacovigilance. Br J Psychiatry 1999;175:576–80. 10.1192/bjp.175.6.576 - DOI - PubMed
    1. The expert Committee for Clozaril patient monitoring service. Available: http://www.clozaril-tekisei.jp/tejun.html [Accessed 27 April 2022].
    1. Novartis Pharmaceuticals Corporation . US package insert of clozapine 2021.
    1. Novartis Pharmaceuticals Corporation . UK package insert of clozapine 2020.

Publication types

MeSH terms