Demler Tammie Lee, Trigoboff Eileen
Drs. Demler and Trigoboff are from Buffalo Psychiatric Center in Buffalo, New York, and are also with the State University of New York at Buffalo.
Psychiatry (Edgmont). 2009 Nov;6(11):29-33.
Flu vaccination is the best protection against seasonal flu; however, as mutated strains of the flu develop and/or unvaccinated people are exposed to the wild virus, antiviral prophylaxis becomes more important. High-risk patients, such as those institutionalized, are particularly vulnerable to adverse drug events and possibly even more so during the course of active viral infection. As clinicians pursue antiviral treatment, it is important to know the potential risks of prescribing concurrent medication regimens. The objective of this study was to contribute to the evolving literature by evaluating the occurrence of blood dyscrasias with concurrent use of oseltamivir and clozapine (a drug used to treat refractory schizophrenia). This study was a retrospective chart review conducted at a 240-bed New York State mental health facility during an influenza outbreak where oseltamivir was distributed to the vast majority of inpatients. The records of 32 patients treated with concurrent oseltamivir and clozapine were assessed for alterations in white blood count and/or absolute neutrophil count at designated periods and compared to baseline lab values. A repeated measures ANOVA was used to analyze the data.
No changes in white blood cell were noted as a result of concomitant oseltamivir and clozapine therapy in the study sample; however, there were statistically significant differences between the absolute neutrophil count from before oseltamivir and the two time periods following oseltamivir administration. Cautions are detailed regarding concomitant use; however, proactive clozapine discontinuation prior to antiviral treatment is unwarranted.
流感疫苗接种是预防季节性流感的最佳方法；然而，随着流感变异毒株的出现和/或未接种疫苗的人接触到野生病毒，抗病毒预防变得更加重要。高危患者，如那些被收容机构收留的人，特别容易发生药物不良事件，在病毒活跃感染期间可能更是如此。当临床医生进行抗病毒治疗时，了解同时开具药物治疗方案的潜在风险很重要。本研究的目的是通过评估同时使用奥司他韦和氯氮平（一种用于治疗难治性精神分裂症的药物）时血液系统异常的发生情况，为不断发展的文献做出贡献。本研究是在纽约州一家拥有240张床位的心理健康机构进行的一项回顾性病历审查，当时正处于流感爆发期间，绝大多数住院患者都分发了奥司他韦。评估了32例同时接受奥司他韦和氯氮平治疗的患者在指定时间段的白细胞计数和/或绝对中性粒细胞计数的变化，并与基线实验室值进行比较。使用重复测量方差分析来分析数据。
在研究样本中，同时使用奥司他韦和氯氮平治疗未导致白细胞变化；然而，奥司他韦治疗前的绝对中性粒细胞计数与奥司他韦给药后的两个时间段之间存在统计学上的显著差异。详细说明了同时使用的注意事项；然而，在抗病毒治疗前主动停用氯氮平是没有必要的。
