Psychiatric Hospital Vrapce, Bolnicka cesta 32, HR-10090 Zagreb, Croatia.
Psychiatr Danub. 2010 Mar;22(1):85-9.
Clozapine is associated with various haematological adverse effects, including leukopenia, neutropenia, agarnulocytosis, leukocytosis, anaemia, eosinophilia, thrombocytopenia and thrombocythaemia. Recognition and treatment of clozapine-related seizures also will become increasingly important as clozapine use grows in the 1990s. The decision to stop clozapine as a result of haematological adverse effects or seizures is a frustrating one for the clinician, and frequently disastrous for the patient. Cessation of treatment results in relapse. In case that patient is unresponsive to other antipsychotic, restarting clozapine should be consider, despite the risk involved. As the risk of a second agranulocytosis is much higher in those patients, various methods of militating against repeat blood dyscrasias have been treated, including granulocyte colony-stimulating factor and lithium. The decision to restart clozapine should be taken on case-by-case basis and should take into account the likely risks and benefits of restarting. Prior response to clozapine and magnitude of patient deterioration on stopping treatment are important factors to take into this consideration. Clozapine-related seizures did not preclude successful treatment with clozapine. A strategy that has been proposed to reduce the occurrence of seizures is the addition of an anticonvulsant agent. However, clozapine does induce a variety of adverse effects, most of which are of limited duration and either preventable or manageable if a number of simple clinical procedures are followed. With careful haematologyc control, the risk of agranulocytosis can be minimized and in case of clozapine related seizures recommendations include dose reduction, electroencephalogram (EEG), plasma-level monitoring and prophylactic antiepileptic treatment. Re-exposure to clozapine may rarely be attempted where there are facilities for very close and frequent monitoring.
氯氮平可引起各种血液学不良反应，包括白细胞减少、中性粒细胞减少、粒细胞缺乏症、白细胞增多、贫血、嗜酸性粒细胞增多、血小板减少和血小板增多症。随着氯氮平在 20 世纪 90 年代的应用越来越广泛，识别和治疗氯氮平相关的癫痫发作也将变得越来越重要。由于血液学不良反应或癫痫发作而停止使用氯氮平对临床医生来说是一个令人沮丧的决定，而且对患者来说通常是灾难性的。停止治疗会导致病情复发。如果患者对其他抗精神病药物没有反应，应考虑重新开始氯氮平治疗，尽管存在风险。由于这些患者再次发生粒细胞缺乏症的风险要高得多，因此已经采取了各种方法来预防血液系统紊乱的再次发生，包括粒细胞集落刺激因子和锂。重新开始氯氮平的决定应根据具体情况做出，并应考虑重新开始的可能风险和益处。以前对氯氮平的反应和停止治疗后患者病情恶化的程度是考虑这一点的重要因素。氯氮平相关的癫痫发作并不排除氯氮平治疗的成功。已经提出了一种策略来减少癫痫发作的发生，即添加抗惊厥药物。然而，氯氮平确实会引起多种不良反应，其中大多数不良反应持续时间有限，如果遵循一些简单的临床程序，这些不良反应是可以预防或控制的。通过仔细的血液学控制，可以最大限度地降低粒细胞缺乏症的风险，如果发生氯氮平相关的癫痫发作，建议包括减少剂量、脑电图（EEG）、血浆水平监测和预防性抗癫痫治疗。在有密切和频繁监测的设施的情况下，可能会很少尝试重新接触氯氮平。
