Clozapine-induced eosinopenia correlates with high drug serum levels: A case report

Adverse hematological profiles associated with chlorpromazine antipsychotic treatment in male rats: Preventive and reversal mechanisms of taurine and coenzyme-Q10

Chlorpromazine (CPZ) is one of the most effective antipsychotic drugs used for managing psychotic related disorders owing to its dopamine receptor blocking action. However, pharmacological investigations against CPZ's cytotoxic effect have remained scarce. Hence, this study investigated the preventive and reversal effects of taurine and coenzyme-Q10 (COQ-10), which are compounds with proven natural antioxidant properties, against CPZ-induced hematological impairments in male rats. In the preventive study, rats received oral saline (10 ml/kg), taurine (150 mg/kg/day), COQ-10 (10 mg/kg/day) or in combination for 56 days, alongside CPZ (30 mg/kg, p.o.) between days 29-56. In the reversal protocol, rats had CPZ repeatedly for 56 days before taurine and COQ-10 treatments or their combination from days 29-56. Rats were also given taurine (150 mg/kg/day), and COQ-10 (10 mg/kg/day) alone for 56 days. Serums were extracted and assayed for hematological, with oxidative and inflammatory markers. CPZ induced decreased red/white blood cells, erythropoietin, platelet count, packed cell volume and hemoglobin, neutrophil, and lymphocyte, which were prevented and reversed by taurine and COQ-10, or their combination. Taurine and COQ-10 improved mean corpuscular volume, hemoglobin concentration, with increased erythropoietin levels relative to CPZ groups. CPZ-induced increased malondialdehyde, tumor necrosis factor-alpha and interleukin-6 levels with decreased interleukin-10, glutathione, and superoxide-dismutase were prevented and reversed by taurine and COQ-10 in comparison with CPZ groups. Taurine and COQ-10 alone notably improved the antioxidant/anti-inflammatory status relative to controls. Among other mechanisms, taurine and COQ-10 abated CPZ-induced hematological deficiencies, via decreased serum levels of oxidative stress, and pro-inflammatory cytokines release, with increased antioxidants and anti-inflammation function.

Haematological side effects associated with clozapine: A retrospective study from India

OBJECTIVE

To evaluate the incidence of clozapine induced haematological side effects among patients receiving clozapine.

METHODS

Data of 333 patients who were on clozapine for a mean duration of 52.96 (45.18) months were reviewed for haematological abnormalities.

RESULTS

Most of the patients (n = 320; 96.1 %) were diagnosed with psychotic disorders, mainly schizophrenia. These patients were receiving clozapine in the dose range of 12.5 mg-600 mg/day, with a mean dose of 212.08 (102.43) mg/day at the time of review of their records. About one-tenth (N = 33; 9.9 %) of patients developed eosinophilia (absolute eosinophil count >600), and 8.2 % (N = 27) experienced thrombocytopenia (platelet count <100,000 cmm³) and 7 patients developed anaemia (haemoglobin level <10 gm%). Only 2 (0.6%) patients developed neutropenia. Mean dose (mg/day) at which haematological side-effects occurred were as follows: 159.85 (87.65) mg/day for eosinophilia; 193.98 (148.93) mg/day for thrombocytopenia; 78.57 (22.49) mg/day for anaemia. In a small proportion of patients, clozapine was discontinued due to the haematological abnormalities and in other patients these abnormalities normalized on its own in subsequent follow-up.

CONCLUSION

Clozapine is associated eosinophilia and thrombocytopenia, which are often benign and in majority of the patients these normalize with time.