Prevention of clozapine-induced granulocytopenia/agranulocytosis with granulocyte-colony stimulating factor (G-CSF) in an intellectually disabled patient with schizophrenia.
A daily white-cell booster let one man with ID stay on life-changing clozapine.
01Research in Context
What this study did
Doctors gave one man with intellectual disability and schizophrenia a daily shot of G-CSF.
The shot boosts white blood cells. They gave it while he kept taking clozapine.
They watched his blood counts every week to see if the drug still had to stop.
What they found
His white cells stayed in the safe zone. Clozapine never had to be halted.
The team kept the medicine that kept his mind calm.
How this fits with other research
Three years earlier Hawley et al. (2004) tracked 35 adults with ID on clozapine.
Seventeen percent had to quit because white cells crashed. Neuringer et al. (2007) shows one way to dodge that drop.
de Kuijper et al. (2014) later showed many adults can taper antipsychotics safely. The two papers sit side-by-side: taper if behavior allows, add G-CSF if clozapine is vital.
Why it matters
If you serve adults with ID and schizophrenia, clozapine may be the last best pill. A simple white-cell booster can keep it on the table. Ask the psychiatrist about G-CSF before the first blood count falls.
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02At a glance
03Original abstract
BACKGROUND: While clozapine is an effective treatment for refractory schizophrenia, its use is limited by haematological side effects. Treatment options that allow continued prescription of clozapine by tackling these side effects will greatly aid patients for whom this medication is all too often their only hope of recovery. METHOD: In this case report, we describe what we believe are two 'firsts' in the clozapine literature: the use of granulocyte-colony stimulating factor on a prophylactic basis in an intellectually disabled patient receiving clozapine for refractory schizophrenia. RESULT: Treatment with granulocyte-colony stimulating factor prevented discontinuation of clozapine, enabling our intellectually disabled patient's recovery from a schizophrenic illness.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2006.00865.x