Clozapine treatment in Australia: a review of haematological monitoring

• Published in: Medical journal of Australia Vol. 168; no. 10; pp. 495 - 497
• Main Authors: Copolov, David L, Bell, William R, Keks, Nicholas A, Strazzeri, Diane C, Benson, Warwick J, Johnson, Gordon F
• Format: Journal Article
• Language: English
• Published: Sydney Australasian Medical Publishing Company 18-05-1998
• Subjects: Adult; Age Distribution; Agranulocytosis - epidemiology; Agranulocytosis - etiology; Antipsychotic Agents - adverse effects; Antipsychotic Agents - blood; Australia - epidemiology; Biological and medical sciences; Clozapine - adverse effects; Clozapine - blood; Drug toxicity and drugs side effects treatment; Female; Humans; Incidence; Leukocyte Count; Male; Medical sciences; Neutropenia - epidemiology; Neutropenia - etiology; Pharmacology. Drug treatments; Population Surveillance; Prospective Studies; Schizophrenia - drug therapy; Sex Distribution; Toxicity: blood; Australia; Oceania; Human; Leukopenia; Neuroleptic; Toxicity; Agranulocytosis; Antipsychotic; Hemopathy; Clozapine; Neutropenia; Incidence
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/j.1326-5377.1998.tb141414.x

BackgroundClozapine is an atypical antipsychotic drug indicated for patients with schizophrenia in whom traditional antipsychotic drugs (such as haloperidol or the phenothiazines) are ineffective, or in those who experience intolerable adverse effects. Clozapine treatment may be complicated by the development of life­ threatening agranulocytosis, so regular haematological monitoring is required.
ObjectivesTo determine the incidence of clozapine‐induced agranulocytosis in Australia and the importance of monitoring white blood cell counts in patients treated with clozapine.
DesignReview of haematological monitoring tor the first three years (June 1993 ‐ July 1996) of operation of the Australian Clozaril (clozapine; Novartis Australia) Patient Monitoring System (CPMS) central database.
ResultsIn the 4061 patients prospectively monitored by the CPMS, the incidence of agranulocytosis, neutropenia and leukopenia combined was 2.6% (n= 104); the incidence of agranulocytosis was 0.9% (n=37). So far there have been no deaths in Australia from the complications of clozapine‐induced agranulocytosis.
ConclusionThe incidence of agranulocytosis and neutropenia associated with clozapine use in Australia is similar to that in the rest of the world. Monitoring the white blood cell counts of patients being treated with clozapine ensures minimal risk to patients who develop agranulocytosis.