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KMID : 0869620000170010141
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Journal of Korean Society of Hospital Pharmacists
2000 Volume.17 No. 1 p.141 ~ p.146
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The Monitoring of Hematological Side Effects of Clozapine
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조유선/Cho, You Sun
양유리/김재연/조영환/노환성/Yang, You Ri/Kim, Jae Yeun/Cho, Young Hwan/Ro, Hwan Seong
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Abstract
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Clozapine is an atypical antipsychotic drug indicated for patients with schizophrenia in whom traditional antipsychotic drugs are ineffective, or in those who experience intolerable adverse effects. Clozapine can cause fatal agranulocytosis and neutropenia, so regular hematological monitoring is required. The incidence of clozapine induced agranulocytosis in Asan Medical Center and the importance of monitoring white blood cell counts in patients treated with clozapine were investigated.
The hematological, demographic and dosage data of patients who received clozapine first from May 1998 to June 1999 were reviewed. Data were available for 90 patients.
The incidence of neutropenia was 6.67% (n=6) and leukopenia, agranulocytosis didn´t occur. Neutropenia occured within the first three months of treatment in all patients who occurred neutropenia. The intervals of drawing blood sample of inpatients and outpatients were 6.4 and 12.1 days (within 18 weeks from the first dose), and 19.3 and 33.3 days (after 18 weeks), respectively (p<0.0001). Neutropenia incidences of the two groups were not significant [7.4 and 2.9%, respectively (p=0.40)]. The rate of registering the Clozaril patient monitoring system (CPMS) was 27.78% (n=25). The monitoring intervals of CPMS and non-CPMS patients were 9.3, 9.6 days (within 18 weeks) and 29.8, 29.2 days (after 18 weeks) (p>0.05). Neutropenia incidences of the two groups were 20.0, 1.5%, respectively (p=0.006). The risk of neutropenia increased with WBC and neutrophil baseline (p<0.001) and had no relationship with sex and dose (p>0.05).
The neutropenia incidence of clozapine treated patients was 6.7% and leukopenia and agranulocytosis did not occur. The relationship between regular monitoring and incidence of the hematological side effects was not statistically significant, but the use of a patient monitoring service kept the hematological risks associated with using clozapine within the acceptable limits, particularly in view of the benefits of this medication in treatment-resistant schizophrenia.
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