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Psychiatr Prax 2005; 32(4): 167-171
DOI: 10.1055/s-2004-828330
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Blutbildveränderungen unter Antipsychotika der zweiten Generation

Haematological Abnormalities during Treatment with Atypical AntipsychoticsJohannes  Thome1 , Daniel  Kopf2
  • 1Department of Psychiatry, School of Medicine, University of Wales Swansea
  • 2Zentralinstitut für Seelische Gesundheit, Mannheim
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Publication History

Publication Date:
25 April 2005 (online)

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Zusammenfassung

Die Gefahr schwerer Blutbildveränderungen stellt einen limitierenden Faktor in der Behandlung mit Clozapin dar. Durch die Entwicklung moderner Antipsychotika der zweiten Generation ist es heute aber möglich, die positiven Effekte dieser Medikamentengruppe zu nutzen, ohne die Risiken einer Clozapin-Behandlung eingehen zu müssen. Allerdings existiert eine Reihe von Kasuistiken, die zeigen, dass auch unter einer Behandlung mit Antipsychotika der zweiten Generation schwere Blutbildveränderungen auftreten können. Die vorliegende Arbeit gibt eine Übersicht über die bisher publizierten Fallberichte und diskutiert die Konsequenzen für die tägliche klinische Praxis.

Abstract

The danger of severe haematological abnormalities limits the use of clozapine in the treatment of psychoses. The development of modern second generation antipsychotics such as olanzapine, risperidone, quetiapine, amisulpride, ziprasidone or aripiprazol, however, makes it possible to use the positive effects of this class of drugs without the risks of a clozapine treatment. Nevertheless, there are several case reports about severe haematological abnormalities even during treatment with these second generation antipsychotics. This review summarises recently published cases and discusses the consequences for the daily clinical work.

Literatur

  • 1 Grohmann R, Rüther E, Sassim N, Schmidt L G. Adverse effects of clozapine.  Psychopharmacology. 1989;  99 S101-S104
    CrossrefPubMedGoogle Scholar
  • 2 Krupp P, Barnes P. Leponex-associated granulocytopenia: a review of the situation.  Psychopharmacology. 1989;  99 S118-S121
    CrossrefPubMedGoogle Scholar
  • 3 Hohl U, Hoffmann-Richter U. Untypischer Granulozytenabfall unter Clozapinbehandlung.  Psychiat Prax. 1993;  20 232-233
    PubMedGoogle Scholar
  • 4 Küchenhoff B. Die wichtigsten Nebenwirkungen unter Clozapin (Leponex) und ihre Behandlung.  Psychiat Prax. 1993;  20 201-206
    PubMedGoogle Scholar
  • 5 Alvir J MJ, Lieberman J A. Agranulocytosis: Incidence and risk factors.  J Clin Psychiat. 1994;  55,9 (Suppl B) 137-138
    PubMedGoogle Scholar
  • 6 Gerson S L. G-CSF and the management of clozapine-induced agranulocytosis.  J Clin Psychiatry. 1994;  55,9 (Suppl B) 139-142
    PubMedGoogle Scholar
  • 7 Hummer M, Kurz M, Barnas C, Saria A, Fleischhacker W W. Clozapine-induced transient white blood count disorders.  J Clin Psychiatr. 1994;  55 429-432
    PubMedGoogle Scholar
  • 8 Alphs L D, Meltzer H Y, Bastani B, Ramirez L F. Side effects of clozapine and their management.  Pharmacopsychiatry. 1991;  24 46
    PubMedGoogle Scholar
  • 9 Pollmächer T, Fenzel T, Mullington J, Hinze-Selch D. The influence of clozapine treatment on plasma granulocyte colony stimulating (G-CSF) levels.  Pharmacopsychiatry. 1997;  30 118-121
    PubMedGoogle Scholar
  • 10 Abdullah N, Voronovitch L, Taylor S, Lippmann S. Olanzapine and haloperidol: potential for neutropenia?.  Psychosomatics. 2003;  44 83-84
    CrossrefPubMedGoogle Scholar
  • 11 Ahokas A, Elonen E. Circadian rhythm of white blood cells during clozapine treatment.  Psychopharmacology. 1999;  144 301-302
    CrossrefPubMedGoogle Scholar
  • 12 Esposito E, Aouillé J, Rouillon F, Limosin F. Morning pseudoneutropenia during clozapine treatment.  World J Biol Psychiatry. 2003;  4 192-194
    PubMedGoogle Scholar
  • 13 Claas F H, Abbott P A, Witvliet M D, D'Amaro J, Barnes P M, Krupp P. No direct clinical relevance of the human leucocyte antigen (HLA) system in clozapine-induced agranulocytosis.  Drug Saf. 1992;  7 (Suppl 1) 3-6
    PubMedGoogle Scholar
  • 14 Amar A, Segman R H, Shtrussberg S, Sherman L, Safirman C, Lerer B, Brautbar C. An association between clozapine-induced agranulocytosis in schizophrenics and HLA-DQB1*0201.  Int J Neuropsychopharmacol. 1998;  1 41-44
    CrossrefPubMedGoogle Scholar
  • 15 Buchmann N, Strous R D, Ulman A M, Lerner M, Kotler M. Olanzapine-induced leukopenia with human leukocyte antigen profiling.  Int Clin Psychopharmacol. 2001;  16 55-57
    CrossrefPubMedGoogle Scholar
  • 16 Guest I, Sokoluk B, MacCrimmon J, Utrecht J. Examination of possible toxic and immune mechanisms of clozapine-induced agranulocytosis.  Toxicology. 1998;  131 54-65
    PubMedGoogle Scholar
  • 17 Sperner-Unterweger B, Gaggl S, Fleischhacker W W, Barnas C, Herold M, Geissler D. Effects of clozapine on hematopoiesis and the cytokine system.  Biol Psychiatry. 1993;  34 536-543
    CrossrefPubMedGoogle Scholar
  • 18 Pisciotta A V, Konings S A. 51Cr release assay of clozapine-induced cytotoxicity: evidence for immunogenic mechanism.  J Clin Psychiatry. 1994;  55 143-148
    PubMedGoogle Scholar
  • 19 Schuld A, Kraus T, Hinze-Selch D, Haack M, Pollmächer T. Granulocyte colony-stimulating factor plasma levels during clozapine- and olanzapine-induced granulocytopenia.  Acta Psychiatr Scand. 2000;  102 153-155
    CrossrefPubMedGoogle Scholar
  • 20 Williams D P, Pirmohamed M, Naisbitt D J, Uetrecht J P, Park B K. Induction of metabolism-dependent and -independent neutrophil apoptosis by clozapine.  Mol Pharmacol. 2000;  58 207-216
    PubMedGoogle Scholar
  • 21 Croarkin P, Rayner T. Acute neutropenia in a patient treated with quetiapine.  Psychosomatics. 2001;  42 368
    CrossrefPubMedGoogle Scholar
  • 22 Palmblad J, Papadaki H A, Eliopoulos G. Acute and chronic neutropenias. What is new?.  J Intern Med. 2001;  250 476-491
    CrossrefPubMedGoogle Scholar
  • 23 Loeffler S, Fehsel K, Henning U, Fischer J, Agelink M, Kolb-Bachofen V, Klimke A. Increased apoptosis of neutrophils in a case of clozapine-induced agranulocytoses. A case report.  Pharmacopsychiatry. 2003;  36 37-41
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Steinwachs A, Grohmann R, Pedrosa F, Rüther E, Schwerdtner I. Two cases of olanzapine-induced neutropenia.  Pharmacopsychiatry. 1999;  32 154-156
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Benedetti F, Cavallaro R, Smeraldi E. Olanzapine-induced neutropenia after clozapine-induced neutropenia.  Lancet. 1999;  354 567
    CrossrefPubMedGoogle Scholar
  • 26 Konakanchi R, Grace J J, Szarowicz R, Pato M T. Olanzapine pronlongation of granulocytopenia after clozapin discontinuation.  J Clin Psychopharmacol. 2000;  20 703-704
    CrossrefPubMedGoogle Scholar
  • 27 Swartz J R, Ananth J, Smith M W, Burgoyne K S, Gadasally R, Arai Y. Olanzapine treatment after clozapine-induced granulocytopenia in 3 patients.  J Clin Psychiatry. 1999;  60 119-121
    PubMedGoogle Scholar
  • 28 Naumann R, Felber W, Heilemann H, Reuster T. Olanzapine-induced agranulocytosis.  Lancet. 1999;  354 566-567
    PubMedGoogle Scholar
  • 29 Kodesh A, Finkel B, Lerner A G, Kretzmer G, Sigal M. Dose-dependent olanzapine-associated leukopenia: three case reports.  Int Clin Psychopharmacol. 2001;  16 117-119
    CrossrefPubMedGoogle Scholar
  • 30 Gajwani P, Tesar G E. Olanzapine-induced neutropenia.  Psychosomatics. 2000;  41 150-151
    CrossrefPubMedGoogle Scholar
  • 31 Etain B, Roubaud L, Heuzey M F Le, Mouren Simeoni M C. Un cas de leucopenie sous traitement par risperidone chez un adolescent.  Encéphale. 2000;  26 81-84
    PubMedGoogle Scholar
  • 32 Godleski L S, Sernyak M J. Agranulocytosis after addition of risperidone to clozapine treatment.  Am J Psychiatry. 1996;  153 735-736
    PubMedGoogle Scholar
  • 33 Clark N, Weissberg E, Noel J. Quetiapine and leukopenia.  Am J Psychiatry. 2001;  158 817-818
    CrossrefPubMedGoogle Scholar
  • 34 Ruhé H G, Becker H E, Jessurun P, Marees C H, Heeringa M, Vermeulen H D. Agranulocytosis and granulocytopenia associated with quetiapine.  Acta Psychiatr Scand. 2001;  104 311-314
    CrossrefPubMedGoogle Scholar
  • 35 Diaz P, Hogan T P. Granulocytopenia with clozapine and quetiapine.  Am J Psychiatry. 2001;  158 651
    CrossrefPubMedGoogle Scholar
  • 36 Oluboka O, Haslam D, Lam T, Bown-Demarco D. Quetiapine-induced leukopenia: possible dosage-related phenomenon.  Can J Psychiatry. 2003;  48 65-66
    PubMedGoogle Scholar
  • 37 Andres E, Maloisel F, Kurtz J E, Kaltenbach G, Alt M, Weber J C, Sibilia J, Schlienger J L, Blickle J F, Brogard J M, Dufour P. Modern management of non-chemotherapy drug-induced agranulocytosis: a monocentric cohort study of 90 cases and review of the literature.  Eur J Intern Med. 2002;  13 324-328
    CrossrefPubMedGoogle Scholar
  • 38 Andres E, Kurtz J E, Maloisel F. Nonchemotherapy drug-induced agranulocytosis: experience of the Strasbourg teaching hospital (1985 - 2000) and review of the literature.  Clin Lab Haematol. 2002;  24 99-106
    CrossrefPubMedGoogle Scholar
  • 39 Safferman A Z, Lieberman J A, Alvir J MJ, Howard A. Rechallenge in clozapine-induced agranulocytosis.  Lancet. 1992;  339 1296-1297
    PubMedGoogle Scholar
  • 40 Sperner-Unterweger B, Czeipek I, Gaggl S, Geissler D, Spiel G, Fleischhacker W W. Treatment of severe clozapine-induced neutropenia with granulocyte colony-stimulating factor (G-CSF). Remission despite continuous treatment with clozapine.  Br J Psychiatry. 1998;  172 82-84
    CrossrefPubMedGoogle Scholar
  • 41 Benkert O, Hippius H. Kompendium der Psychiatrischen Pharmakotherapie. 4. Auflage. Berlin u. a.; Springer 2003
    Google Scholar
  • 42 Hagg S, Rosenius S, Spigset O. Long-term combination treatment with clozapine and filgrastim in patients with clozapine-induced agranulocytosis.  Int Clin Psychopharmacol. 2003;  18 173-174
    PubMedGoogle Scholar
  • 43 Klimke A, Klieser E. Das atypische Neuroleptikum Clozapin (Leponex®) - aktueller Kenntnisstand und neuere klinische Aspekte.  Fortschr Neurol Psychiat. 1995;  63 173-193
    PubMedGoogle Scholar

Prof. Dr. med. Dr. phil. Johannes Thome

Department of Psychiatry · School of Medicine · University of Wales Swansea

Grove Building

Singleton Park

Swansea, SA2 8PP

United Kingdom

Email: j.thome@swan.ac.uk