title: Clozapine-induced neutropenia in children: management with lithium carbonate.
abstract: Clozapine, an atypical antipsychotic, is the most effective medication for treatment-resistant schizophrenia, but its use is limited by the high risk of neutropenia and agranulocytosis. In children, the rate of clozapine-induced neutropenia is even higher than in adults. We report two cases of children 7- and 12-years old diagnosed with very early onset schizophrenia, who developed neutropenia when treated with clozapine. In both cases addition of lithium carbonate elevated the white blood count (WBC) allowing clozapine rechallenge. WBC and total neutrophil count remained stable long-term with coadministration of clozapine (400-425 mg per day) and lithium with the blood level of 0.8-1.1 microg/mL. This report supports the use of adjunct lithium for clozapine-induced neutropenia as a safe and successful strategy in children.
authors.affiliation: Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sporn
authors.forename: Nitin
authors.initials: N
authors.lastname: Gogtay
authors.forename: Roberto
authors.initials: R
authors.lastname: Ortiz-Aguayo
authors.forename: Cara
authors.initials: C
authors.lastname: Alfaro
authors.forename: Julia
authors.initials: J
authors.lastname: Tossell
authors.forename: Marge
authors.initials: M
authors.lastname: Lenane
authors.forename: Peter
authors.initials: P
authors.lastname: Gochman
authors.forename: Judith L
authors.initials: JL
authors.lastname: Rapoport
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007958:Leukocyte Count; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D012561:Schizophrenia, Childhood / Q000150:complications / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D003024:Clozapine