Long-Term Treatment of Clozapine-Induced Leukopenia With Lithium: Fast-Onset Agranulocytosis Following Lithium Discontinuation

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To the Editor: The atypical antipsychotic clozapine is the most effective medication for treatment-resistant schizophrenia and schizoaffective disorder, improving psychopathology and quality of life; however, its use is limited by the risk of neutropenia (2.7%) and agranulocytosis (0.9%). In France, after initiation of clozapine, blood monitoring must occur on a weekly basis for the first 4 months, after which patients undergo monthly monitoring.

Lithium carbonate is known to increase the white blood cell (WBC) count by a mechanism that is still unclear but that may involve demargination, stimulation of granulocyte-macrophage colony-stimulating factor, and stimulation of cytokines.