Lithium and Clozapine Rechallenge: A Retrospective Case Analysis
J Clin Psychiatry 2006;67(5):756-760
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Clozapine is a uniquely
effective antipsychotic, although its use is limited
by the risk of neutropenia. Lithium is
occasionally prescribed during a clozapine rechallenge,
with the hope that it will prevent a second
neutropenia or agranulocytosis. There are concerns,
however, that lithium use will mask the onset of a
neutropenia, leading to a more severe dyscrasia. The
objective of this analysis was to determine the
utility and safety of lithium coprescription in clozapine rechallenge.
Method: A retrospective case analysis
was performed of all patients who had experienced
a previous clozapine-induced blood dyscrasia and had a clozapine rechallenge with
lithium coprescribed in a tertiary referral center
between September 1998 and September 2003.
Results: Twenty-five patients met the
study criteria; 1 patient (4%) had a second episode
of neutropenia or agranulocytosis while undergoing the rechallenge. This rate was significantly
lower (p = .021) than the national (U.K.) rate
(21.2%). Although recurrent dyscrasias were not
more common, or more severe, than those seen with rechallenge in general, our single case did
show some evidence that the patient's neutropenia
was masked by lithium use.
Conclusion: This study provides support
for the utility of lithium in preventing neutropenias
in rechallenge; extra vigilance may be required, however, to detect masked blood dyscrasias.