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CAN WE PREVENT BLOOD DYSCRASIA (LEUCOPENIA, THROMBOCYTOPENIA) AND EPILEPTIC SEIZURES INDUCED BY CLOZAPINE

Miroslav Herceg ; Psychiatric Hospital Vrapče, Bolnička cesta 32, HR-10090 Zagreb, Croatia
Lana Mužinić ; Psychiatric Hospital Vrapče, Bolnička cesta 32, HR-10090 Zagreb, Croatia
Vlado Jukić ; Psychiatric Hospital Vrapče, Bolnička cesta 32, HR-10090 Zagreb, Croatia

Sažetak

Clozapine is associated with various haematological adverse effects, including leukopenia, neutropenia, agarnulocytosis, leukocytosis, anaemia, eosinophilia, thrombocytopenia and thrombocythaemia. Recognition and treatment of clozapine-related seizures also will become increasingly important as clozapine use grows in the 1990s.
The decision to stop clozapine as a result of haematological adverse effects or seizures is a frustrating one for the clinician, and
frequently disastrous for the patient. Cessation of treatment results in relapse. In case that patient is unresponsive to other antipsychotic, restarting clozapine should be consider, despite the risk involved. As the risk of a second agranulocytosis is much
higher in those patients, various methods of militating against repeat blood dyscrasias have been treated, including granulocyte
colony-stimulating factor and lithium. The decision to restart clozapine should be taken on case-by-case basis and should take into
account the likely risks and benefits of restarting. Prior response to clozapine and magnitude of patient deterioration on stopping
treatment are important factors to take into this consideration. Clozapine-related seizures did not preclude successful treatment with
clozapine. A strategy that has been proposed to reduce the occurrence of seizures is the addition of an anticonvulsant agent.
However, clozapine does induce a variety of adverse effects, most of which are of limited duration and either preventable or
manageable if a number of simple clinical procedures are followed. With careful haematologyc control, the risk of agranulocytosis
can be minimized and in case of clozapine related seizures recommendations include dose reduction, electroencephalogram (EEG), plasma-level monitoring and prophylactic antiepileptic treatment. Re-exposure to clozapine may rarely be attempted where there are facilities for very close and frequent monitoring.

Ključne riječi

clozapine; blood dyscrasia; leucopenia; thrombocytopenia; epileptic seizures

Hrčak ID:

48625

URI

https://hrcak.srce.hr/48625

Datum izdavanja:

10.2.2010.

Posjeta: 2.290 *