Chlorpromazine agranulocytosis with

Skin reactions occur early in therapy but can subside with continued treatment. Jaundice, which can also occur early, is of the cholestatic type, similar to that attributed to chlorpromazine. Agranulocytosis is a rare complication, as are cases of leukocytosis, leukopenia, and eosinophilia. There are no data on the incidence of antidepressant-induced agranulocytosis, except to note that it is rare with all of the agents discussed in this chapter. 

In 42 elderly patients (mean age 67 years) with schizophrenia randomly assigned to clozapine, titrated to 300 mg/day (n = 24), or chlorpromazine, titrated to a maximum of 600 mg/day (n = 18), the two medications were equally effective at 5 weeks (47). In each group there was one patient with a serious and potentially fatal adverse effect agranulocytosis in the clozapine group and paralytic ileus in the chlorpromazine group both drugs significantly lowered the white cell count. 

A 40-year-old woman developed agranulocytosis after taking risperidone for 2 weeks (175). She had also developed agranulocytosis after treatment with several other antipsychotic drugs (chlorpromazine, haloperi-dol, and zuclopenthixol). 

The Committee on Safety of Medicines and the erstwhile Medicines Control Agency in the UK received 999 reports of hemopoietic disorders related to neuroleptic drugs between 1963 and 1996 there were 65 deaths (22). There were 182 reports of agranulocytosis chlorpromazine and thioridazine were associated with the highest number of deaths—27 of 56 and nine of 24 respectively. 

Blood Dyscrasias Mild leukocytosis, leukopenia, and eosinophilia occasionally occur with antipsychotic treatment, particularly with clozapine and less often with phenothiazines of low potency. It is difficult to determine whether leukopenia that develops during the administration of such agents is a forewarning of impending agranulocytosis. This serious comphcation occurs in not more than 1 in 10,000 patients receiving chlorpromazine or other low-potency agents (other than clozapine) it usually appears within the first 8-12 weeks of treatment. 

More alarming is the brief case report of a 37-year-old woman treated with intravenous chloripramine for 3 weeks (up to 250 mg daily) who developed a complete agranulocytosis. Fortunately the patient survived following massive antibiotic treatment for a severe infection. The author speculates on the chemical similarity to chlorpromazine (a chlorine atom in the 2 position) as a possible factor in causation as well as the intravenous use of large dosages (79 ). 

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