Adjunctive use of lithium carbonate for the management of neutropenia in clozapine-treated children

✍ Scribed by Anand Mattai; Lawrence Fung; Jennifer Bakalar; Gerald Overman; Julia Tossell; Rachel Miller; Judith Rapoport; Nitin Gogtay

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 90 KB
• Volume: 24
• Category: Article
• ISSN: 0885-6222
• DOI: 10.1002/hup.1056

✦ Synopsis

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. Published in 2009 by John Wiley & Sons, Ltd.