title: Adjunctive use of lithium carbonate for the management of neutropenia in clozapine-treated children.
abstract: OBJECTIVE
  Clozapine, a dibenzodiazepine antipsychotic, is the most effective medication for treatment-resistant schizophrenia. However, its use has been limited by the high risk of neutropenia. In children, the rate of neutropenia is higher when compared to adults. We decided to explore the use of lithium to manage neutropenia in childhood-onset schizophrenia (COS) through a systematic audit of COS cases.
  
  
  METHODS
  Medical records were reviewed for patients with COS who had been treated with the combination of clozapine and lithium carbonate.
  
  
  RESULTS
  Seven patients were found to have been treated with both clozapine and lithium. After initiation of lithium, ANC increased significantly in six out of seven subjects by 29 to 106% with a mean of 66%. In addition, six out of seven subjects continued using both clozapine and lithium for over 2 years (range: 2.0-7.2 years) and do not have immediate plans for discontinuation of either medications.
  
  
  CONCLUSIONS
  Our study bolsters support for the use of lithium in the management of neutropenia in children treated with clozapine. Although the coadministration of lithium and clozapine appears effective in the management of neutropenia, it is not without its risks and clinicians must be diligent in their joint use of these medications.
authors.affiliation: Child Psychiatry Branch, NIMH, NIH, MD 20892-1600, USA. mattaia@mail.nih.gov
authors.forename: Anand
authors.initials: A
authors.lastname: Mattai
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fung
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bakalar
authors.forename: Gerald
authors.initials: G
authors.lastname: Overman
authors.forename: Julia
authors.initials: J
authors.lastname: Tossell
authors.forename: Rachel
authors.initials: R
authors.lastname: Miller
authors.forename: Judith
authors.initials: J
authors.lastname: Rapoport
authors.forename: Nitin
authors.initials: N
authors.lastname: Gogtay
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D003024:Clozapine / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D003024:Clozapine