Clozapine/sodium valproate
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Agranulocytosis: case report A 38-year-old man developed agranulocytosis during treatment with clozapine and sodium valproate for resistant schizophrenia [not all dosages stated; routes and durations of treatments to reactions onsets not stated]. The man had been diagnosed with paranoid schizophrenia in 1999. Additionally, he had resistant schizophrenia. He had been treated with various unspecified antipsychotics without obtaining a clinical remission. In 2016, he started receiving clozapine, the dose of which was subsequently increased to 550 mg/day. Additionally, he received sodium valproate 3000 mg/day. In 2018, he was hospitalised for an exacerbation of positive symptoms following discontinuation of clozapine and sodium valproate treatment. He again started receiving clozapine and sodium valproate. Subsequently, he developed agranulocytosis. The treatment with clozapine and sodium valproate was therefore discontinued, and the neutrophil counts normalised. Thereafter, clozapine alone was re-initiated until its dosage reaches to 500 mg/day (aplasmatic clozapine concentration at 702 ng/mL). No dyscrasia was observed during the first 4 months. Subsequently, he discontinued clozapine due to exacerbation of positive symptoms. The man was then re-initiated on clozapine again. After 3 weeks of progressive re-introduction, he developed neutropenia. The treatment with clozapine was therefore changed to olanzapine and zuclopenthixol [final outcome not stated]. Author comment: "It is important to note that the first episode of blood dyscrasia (agranulocytosis) occured with the concommitant reintroduction of sodium valproate and clozapine." Romeo B, et al. Failure of rechallenge clozapine after agranulocytosis: A case report. L’Encephale 45: 449-450, No. 5, Nov 2019. Available from: URL: http:// 803440846 doi.org/10.1016/j.encep.2019.02.003 - France
0114-9954/19/1784-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 21 Dec 2019 No. 1784
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