Adjunctive use of lithium carbonate for the management of neutropenia in clozapine-treated children.
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.
Mattai
Anand
A
Child Psychiatry Branch, NIMH, NIH, MD 20892-1600, USA. mattaia@mail.nih.gov
Fung
Lawrence
L
Bakalar
Jennifer
J
Overman
Gerald
G
Tossell
Julia
J
Miller
Rachel
R
Rapoport
Judith
J
Gogtay
Nitin
N
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
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D003024:Clozapine