Deptments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
BMC Psychiatry. 2021 Feb 6;21(1):76. doi: 10.1186/s12888-021-03073-w.
Neutropenia, a decrease in total number of neutrophils below 1500/mm and particularly severe neutropenia, defined as neutrophils less than 500/mm, is a potential adverse effect of antipsychotic medications that can lead to increased risk of infections and death. However, much of the attention on the potential adverse effect is centered exclusively on clozapine, which remains the only antipsychotic medication in the United States requiring standardized monitoring of blood work. We demonstrate here that paliperidone can also cause neutropenia and therefore clinicians should be aware of this possibility especially during initiation of treatment.
The following report presents the case of a 23-year-old African American male with first episode psychosis who developed neutropenia after initiation of paliperidone. Neutropenia resolved after discontinuation of paliperidone and initiation of an alternative antipsychotic, haloperidol.
This case report demonstrates an example of paliperidone induced neutropenia which resolved with a switch to haloperidol. We conclude that when initiating paliperidone, clinicians should be more aware of the risk of neutropenia. Moreover, neutropenia may be a more common and overlooked issue in patients on antipsychotic medications other than clozapine and increased awareness of comparative risk across antipsychotics could help direct treatment.
中性粒细胞减少症，即中性粒细胞总数降至 1500/mm 以下，尤其是严重中性粒细胞减少症，定义为中性粒细胞数低于 500/mm，是抗精神病药物的一种潜在不良反应，可能导致感染和死亡风险增加。然而，对抗精神病药物潜在不良反应的关注主要集中在氯氮平上，它仍然是美国唯一需要标准化监测血液检查的抗精神病药物。我们在此证明，帕利哌酮也可能引起中性粒细胞减少症，因此临床医生应特别注意这种可能性，尤其是在开始治疗时。
以下报告介绍了一名 23 岁的非洲裔美国男性首次出现精神病症状，在开始使用帕利哌酮后出现中性粒细胞减少症。停用帕利哌酮并改用另一种抗精神病药物氟哌啶醇后，中性粒细胞减少症得到缓解。
本病例报告表明了帕利哌酮引起的中性粒细胞减少症的一个例子，改用氟哌啶醇后得到缓解。我们得出结论，当开始使用帕利哌酮时，临床医生应更加注意中性粒细胞减少症的风险。此外，中性粒细胞减少症可能是除氯氮平以外的抗精神病药物患者中更为常见且被忽视的问题，增加对抗精神病药物相对风险的认识有助于指导治疗。
