background Clozapine is the antipsychotic drug of choice in treatment-resistant schizophrenia. Unfortunately it is associated with lifethreatening side effects of leukopenia and agranulocytosis.
aim (1) To study the clinical results of a rechallenge with clozapine in a patient suffering from treatment-resistant schizophrenia with previous complication of leukopenia on clozapine; (2) To observe the efficacy of lithium augmentation on clozapine-induced leukopenia.
method Lithium was added to clozapine when wbc reached 3 × 10-9/l in a patient where a good antipsychotic response was achieved on clozapine where other antipsychotics were ineffective. Twice weekly laboratory data were obtained and literature/available reports on this topic were investigated (Medline and Cochrane database; December 1980 to October 2006.). Re-test of the lithium effect was done when lithium was stopped for two weeks.
results There was a rapid recovery of wbc-count (white blood cells) within one week after adding lithium to clozapine. When lithium was stopped, a sudden decrease of the wbc-count was noted. Restart of lithium led to an increased wbc-count. The side effect of lithium increasing the wbc-count is well documented in the literature.
conclusion Clozapine-induced leukopenia can be successfully treated with lithium.