Hematological adverse events in clozapine-treated children and adolescents.
OBJECTIVE
To retrospectively examine rates of hematological adverse events (HAEs) in psychiatrically ill, hospitalized children treated with clozapine.


METHODS
Clozapine treatment was administered in an open-label fashion using a flexible titration schedule, and data from weekly complete blood counts was obtained. The rate of neutropenia and agranulocytosis (HAEs) development was determined for 172 eligible patients (mean age at clozapine initiation, 15.03 +/- 2.13 years) with a median observation period of 8 months.


RESULTS
Neutropenia (absolute neutrophil count <1,500/mm) developed in 23 (13%) patients and agranulocytosis (absolute neutrophil count <500/mm) in one (0.6%) patient. The cumulative probability of developing an initial HAE at 1 year of clozapine treatment was 16.1% (95% confidence interval 9.7%-22.5%). Eleven (48%) of 24 patients who developed an HAE were successfully rechallenged on clozapine. Eight (5%) of 172 patients from this sample eventually discontinued clozapine because of an HAE (one agranulocytosis, seven neutropenia).


CONCLUSIONS
The occurrence of HAEs is a significant risk associated with the administration of clozapine. However, in this sample, few children actually discontinued therapy because of an HAE and the incidence of agranulocytosis does not appear higher than what has been reported in the adult literature.
Gerbino-Rosen
Ginny
G
Bronx Children's Psychiatric Center, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, USA.
Roofeh
David
D
Tompkins
D Andrew
DA
Feryo
Doug
D
Nusser
Laurie
L
Kranzler
Harvey
H
Napolitano
Barbara
B
Frederickson
Anne
A
Henderson
Inika
I
Rhinewine
Joe
J
Kumra
Sanjiv
S
D000293:Adolescent; D000380:Agranulocytosis / Q000139:chemically induced* / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology; D011618:Psychotic Disorders / Q000188:drug therapy*; D012189:Retrospective Studies
D014150:Antipsychotic Agents; D003024:Clozapine