The British Journal of Psychiatry (2006) 188: 255-263. doi: 10.1192/bjp.188.3.255
© 2006 The Royal College of Psychiatrists
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Rechallenge with clozapine following leucopenia or neutropenia during previous therapy

LOUISA R. DUNK, MB ChB, Medical Adviser

Stamford

LINDA J. ANNAN, BPharm, MRPharmS and CHRISTOPHER D. ANDREWS, PhD, CStat

Novartis Pharmaceuticals UK Ltd, Camberley, UK

Correspondence: Dr L. R. Dunk, Histopathology Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. E-mail: louisa.dunk{at}btinternet.com

Declaration of interest L.D. has undertaken consultancy for Novartis UK and Novartis Australia and received a fee from Novartis Australia for the preparation of this paper; she was formerly employed by Novartis UK.L.A. and C.A. are employed by Novartis UK.

Background Further treatment with clozapine is contraindicated in any patient who has previously experienced leucopenia or neutropenia during clozapine therapy.

Aims To investigate the results of such a rechallenge in 53 patients.

Method An analysis was made of the demographic, haematological and outcome data of patients in the UK and Ireland who were rechallenged with clozapine following leucopenia or neutropenia during previous clozapine therapy.

Results Of 53 patients who were rechallenged, 20 (38%) experienced a further blood dyscrasia. In 17 of these 20 patients (85%) the second blood dyscrasia was more severe (P<0.001), in 12 (60%) it lasted longer (P=0.0368) and in 17 (85%) it occurred more quickly on rechallenge (P<0.001). Of the original 53 patients, 55% (29 patients) are still receiving clozapine.

Conclusions No clear risk factor for repeat blood dyscrasias was identified. Despite this, after risks and benefits have been considered, rechallenge may well be justified in some patients.


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