Clozapine agranulocytosis with

Chengappa KNR, Gopalani A, Haught MK, et al. The treatment of clozapine-associated agranulocytosis with granulocyte colony-stimulating factor (G-CSF). Psychopharmacol Bull 1996 32 111-121. 

In view of the association of agranulocytosis with clozapine and of aplastic anemia with remoxipride, hemopoietic disorders have been studied using information... 

In the past, clozapine agranulocytosis was associated with HLA variants in Ashkenazi Jews [79],... 

Gullion G, Yeh HS. Treatment of clozapine-induced agranulocytosis with recombinant granulocyte colony stimulating factor. J Clin Psychiatry... 

Classic examples of Type B reactions are anaphylaxis with penicillins, hepatitis with halothane and agranulocytosis with clozapine. Additional categories of ADRs have also been suggested, as follows ... 

Corzo, D., et al., "The Major Histocompatibility Complex Region Marked by HSP and HSP70-2 Variant is Associated with Clozapine-induced Agranulocytosis in Two Different Ethnic Groups," Blood, 86, 3835-3840 (1995). 

The most talked about and concerning side effect of clozapine is a potentially dangerous reduction in the number of white blood cells. This side effect, called agranulocytosis, occurs in about 1% of patients treated with clozapine. Although we... 

Carbamazepine and possibly the antidepressant mirtazapine should not be coadministered with clozapine because these drugs may further increase the risk of agranulocytosis. In addition, the antidepressant bupropion should not be coprescribed with clozapine because it may increase clozapine s seizure risk. 

Care should be taken when prescribing other medications with clozapine. The mood stabilizer carbamazepine (Tegretol) and perhaps the antidepressant mirtazap-ine (Remeron) should not be taken with clozapine because they might further increase the risk of agranulocytosis. Likewise, the antidepressant bupropion (Wellbutrin, Zyban) should not be taken with clozapine because it may add to the seizure risk. 

Clozapine is an atypical antipsychotic that is usually used in patients who are inadequately controlled with other antipsychotics. The reason is that clozapine is associated with a risk of potentially fatal agranulocytosis. As with other atypicals, side-effects of clozapine include occurrence of hyperglycaemia and diabetes. 

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. 

Clozapine Myeloproliferative disorders uncontrolled epilepsy history of clozapine-induced agranulocytosis or severe granulocytopenia should not be used with other agents having a well-known potential to cause agranulocytosis or suppress bone marrow function. 

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