title: Add-on filgrastim during clozapine rechallenge unsuccessful in preventing agranulocytosis.
abstract: Granulocyte colony-stimulating factor agents such as filgrastim can be administered in order to reduce the duration of clozapine-induced agranulocytosis. Successful long-term combination treatment with filgrastim and clozapine in patients with previous clozapine-induced agranulocytosis has been described in several cases. We describe a patient with schizophrenia who developed agranulocytosis during treatment with clozapine and who did not respond to other antipsychotics. Add-on treatment with filgrastim during a clozapine rechallenge did not prevent the reoccurrence of agranulocytosis, and clozapine treatment had to be discontinued. Our case suggests that add-on filgrastim is a therapeutic option when clozapine is rechallenged, but physicians should be aware of the potential dangers especially severe clozapine-induced agranulocytosis.
authors: Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, The Netherlands. Electronic address: a.w.p.hazewinkel@lumc.nl.
authors: Andreia W P
authors: AW
authors: Hazewinkel
authors: Jan P A M
authors: JP
authors: Bogers
authors: Erik J
authors: EJ
authors: Giltay
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced* / Q000517:prevention & control; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D003024:Clozapine; D000069585:Filgrastim
keywords: Agranulocytosis; Clozapine; Filgrastim; Granulocyte colony-stimulating factor; Human; Leukopenia; Schizophrenia