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How do you treat clozapine agranulocytosis?
While there is no FDA approved treatment for clozapine induced agranulocytosis, pharmacologic methods have been utilized in clinical practice. These include lithium and granulocyte colony stimulating factor.
What should you monitor when taking clozapine?
Before you can start clozapine and during treatment, you must have regular blood tests to measure the number of neutrophils you have in your blood. This test is called absolute neutrophil count (ANC). If the number of neutrophils, or ANC, is too low, you may have to stop clozapine.
What blood test is required to monitor for adverse effects related to clozapine?
Blood monitoring is mandatory for the prescription of clozapine. White blood cell (WBC) and Neutrophil count (NC) are measured weekly for 18 weeks and every 28 days thereafter, continuing for the duration of treatment with clozapine.
Does clozapine have a black box warning?
Clozaril carries five serious warnings, called black box warnings, about possible severe side effects and drug interactions. 2 Because of these warnings, Clozaril can only be prescribed through a special program that restricts distribution called the Clozapine Risk Evaluation and Mitigation Strategies (REMS) Program.
How long can you take clozapine?
Generally, Clozapine treatment should be continued for at least six months, unless you develop a side effect that means you have to stop the medicine. It has been shown that about six out 10 people with treatment-resistant schizophrenia will benefit from taking Clozapine.
Is it possible for clozapine to cause agranulocytosis?
Wider use of clozapine, one of the most effective antipshychotic drugs, is precluded by its propensity to cause agranulocytosis. Currently, clozapine is used for treatment-resistant schizophrenia, with mandatory blood count monitoring for the duration of treatment. Agranulocytosis occurs in up to 0. …
When to draw blood with low clozapine ANC?
The monitoring protocol, including how and when to respond to low ANC results, is at https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/ANC_Table.pdf . When patients’ ANC counts are not dangerous but near a monitoring threshold, labs are sometimes drawn later in the day, when white blood counts can be higher.
Is the neutrophil count cutoff for clozapine too high?
The results suggest that the risk of agranulocytosis associated with clozapine may be overstated. They also appear to lend support to the 2015 decision by the Food and Drug Administration to lower the neutrophil count cutoff at which patients are required to discontinue Clozaril from 1500/mm3 to 1000/mm3.
What kind of monitoring is needed for clozapine?
Monitoring clozapine patients Prior to initiation. Before starting clozapine, patients should have a thorough medical evaluation, including baseline ECG, chest X-ray and possibly an echocardiogram. However, there is no evidence that routine repetition of ECG or echocardiograms will reliably detect clozapine induced cardiac toxicity 3,7.