title: Haematological toxicity of clozapine and some other drugs used in psychiatry.
abstract: OBJECTIVE
  To review recent work on the haematological toxicity of clozapine and some other drugs used in psychiatry concerning especially (i) the mechanism of antipsychotic-induced neutropenia/agranulocytosis, (ii) criteria for clozapine prescribing in benign ethnic neutropenia, (iii) options in the event of worrying falls in white cell count (WCC), including measures to boost WCC with or without continued clozapine administration, (iv) criteria for clozapine rechallenge in the event that treatment was suspended because of a fall in WCC and (v) safety concerns regarding clozapine in children/adolescents.
  
  
  CONCLUSIONS
  There remain several difficult areas, including the criteria for clozapine rechallenge. Experience has emphasised (i) the role of appropriate timing of WCC sample collection to ensure that clozapine is not withdrawn unnecessarily and (ii) the success of agents such as filgrastim in promoting rapid production of granulocytes if the situation so demands. On the other hand, the use of lithium to promote a leucocytosis has taken hold without a clear risk: benefit analysis. Be this as it may, should patients decide that they no longer wish to undergo WCC monitoring after 12 months on clozapine, cessation of monitoring is probably preferable to stopping the drug since overall mortality is decreased in patients treated with clozapine.
authors.affiliation: Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Patty M M
authors.initials: PM
authors.lastname: Nooijen
authors.forename: Felix
authors.initials: F
authors.lastname: Carvalho
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Flanagan
mesh_terms: D000380:Agranulocytosis / Q000097:blood / Q000139:chemically induced; D000818:Animals; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000506:poisoning; D003024:Clozapine / Q000009:adverse effects* / Q000506:poisoning; D006402:Hematologic Diseases / Q000097:blood / Q000139:chemically induced*; D006801:Humans; D001523:Mental Disorders / Q000097:blood / Q000188:drug therapy*; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine