Agranulocytosis treatment

BENZODIAZEPINES Carbamazepine may cause aplastic anemia and agranulocytosis. During treatment blood studies are performed frequently If evidence of bone marrow depression is obtained (eg, the patient s platelet... 

The drug was subsequently reintroduced for treatment-resistant or treatment-intolerant patients in the UK and USA in 1990. The drug is completely free of extrapyramidal side effects but has to be monitored for the development of neutropenia and agranulocytosis. Other problems include sialorrhoea, sedation, reduction in seizure... 

Quetiapine (Seroquel). Another atypical antipsychotic, quetiapine has also been approved by the FDA for the treatment of acute mania. It is usually administered twice daily at doses of 150-750mg/day. Like its counterparts, quetiapine is a well-tolerated medication. Its common side effects are drowsiness, dizziness, and headache. It causes less weight gain than olanzapine or clozapine but more than ziprasidone or aripiprazole. Quetiapine also does not cause agranulocytosis nor does it increase the risk of seizures. It can occasionally cause mild changes in liver function tests, but these usually return to normal even if the patient continues taking quetiapine. 

Side-effects of corbamazepine include blood disorders such as thrombocytopenia, leucopenia, aplastic anaemia and agranulocytosis. Patients ore therefore advised to stop treatment and contact a healthcare provider if they develop symptoms of sore throat, fever, rash, mouth ulcers, bleeding or bruising. 

Clozapine is considered to be the gold standard of treatment of schizophrenia with patients usually moving onto it after treatment failure with two other antipsychotics. Yet the history of it is quite chequered. When it was first introduced onto the European market in 1975 it was used freely with no restrictions on use. Following the death of eight patients in Finland from agranulocytosis, a very rare (< 1 %) but often fatal condition occur-ing normally within the first few months of use, it was voluntarily taken off the market. 

Because procainamide has the potential to produce serious hematologic disorders (0.5%), particularly leukopenia or agranulocytosis (sometimes fatal), reserve its use for patients in whom the benefits of treatment clearly outweigh the risks. 

Some patients may be sensitive to treatment with sulfasalazine. Various desensitization-like regimens have been reported to be effective. These regimens suggest starting with a total daily dose of 50 to 250 mg initially, and doubling it every 4 to 7 days until the desired therapeutic level is achieved. If the symptoms of sensitivity recur, discontinue sulfasalazine. Do not attempt desensitization in patients who have a history of agranulocytosis, or who have experienced an anaphylactoid reaction while previously receiving sulfasalazine. 

Agranulocytosis Because of a significant risk of agranulocytosis, a potentially life-threatening adverse reaction, reserve clozapine for use in the treatment of severely ill schizophrenic patients who fail to show an acceptable response to adequate courses of standard antipsychotic drug treatment because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse effects from those drugs. Consequently, before initiating treatment with clozapine, it... 

Retinitis pigmentosa and agranulocytosis are rare idiosyncratic reactions. During treatment with clozapine leucocyte counts should be carried out frequently, especially the first few month, as there is a considerable risk of agranulocytosis. 

Amodiaquine (Camoquin) is another 4-aminoquinoline derivative whose antimalarial spectrum and adverse reactions are similar to those of chloroquine, although chloroquine-resistant parasites may not be amodi-aquine-resistant to the same degree. Prolonged treatment with amodiaquine may result in pigmentation of the palate, nail beds, and skin. There is a 1 2000 risk of agranulocytosis and hepatocellular dysfunction when the drug is used prophylactically. 

Although dapsone (Avlosulfon) was once used in the treatment and prophylaxis of chloroquine-resistant P. falciparum malaria, the toxicities associated with its administration (e.g., agranulocytosis, methemoglobinemia, hemolytic anemia) have severely reduced its use. 

The risk of agranulocytosis and seizures limits use to patients who have failed to respond or were unable to tolerate treatment with appropriate courses of standard antipsychotics. 

Clozapine was the first atypical antipsychotic released in the United States. However, clozapine is associated with the risk of leukopenia and, potentially, lethal agranulocytosis. Because of these concerns, hematological monitoring during clozapine pharmacotherapy is required (Alphs and Anand, 1999). Due to these hematological risks, clozapine is indicated only for patients with treatment-resistant schizophrenia. The other atypical antipsychotics, risperidone, olanzapine, quetiapine, and ziprasidone, that are marketed in the United States can be used as first-line treatments for adults with schizophrenia. 

Hematological Agranulocytosis, leukopenia, neutropenia N/A Complete blood count with differential at baseline and if symptoms of infection, pallor, or bruising develop shortly after treatment initiation White blood counts weekly for 6 months, then every other week thereafter if treated with clozapine... 

Clozapine, the first of the class of atypical antipsychotic drugs, rarely causes EPS, and it is the only antipsychotic drug that is not associated with treatment-emergent tardive dyskinesia. Because of the approximately 1% risk of potentially fatal agranulocytosis, the use of clozapine is restricted to patients who have not responded to or cannot tolerate other antipsychotic drugs. 

Fever. For unclear reasons, clozapine is associated with benign, transient temperature increases, generally within the first 3 weeks of treatment. Patients taking clozapine who develop fevers should be evaluated for infections, agranulocytosis, and NMS. 

---