Kamei Shintaro, Tanaka Ryota, Hirakawa Hirofumi, Iwao Motoshi, Kawanaka Rikako, Tatsuta Ryosuke, Terao Takeshi, Itoh Hiroki
Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, 879-5593, Japan.
Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu-shi, Oita, 879-5593, Japan.
J Pharm Health Care Sci. 2021 Dec 2;7(1):45. doi: 10.1186/s40780-021-00227-6.
Although clozapine is the optimal drug for patients with treatment-resistant schizophrenia, the drug has harmful adverse effects such as leukopenia. Adenine and cepharanthine are known to be effective for radiation- or drug-induced leukopenia. Furthermore, ninjin-yoei-to, a Chinese herbal medicine, augments the production of granulocyte-macrophage colony-stimulating factor. Thus, these drugs may be useful for clozapine-induced leukopenia.
A 21 years-old woman with schizophrenia was hospitalized for initiation of clozapine treatment. Despite concomitant use of adenine, cepharanthine, and lithium carbonate having activities of increasing leukocytes, a decrease in leukocyte counts occurred after the initiation of clozapine. Additional administration of ninjin-yoei-to increased leukocyte counts, which prevented the development of leukopenia.
This is the first case that concomitant use of adenine, cepharanthin, and ninjin-yoei-to exhibited the effectiveness of reversing the decrease in leukocytes caused by clozapine. Monitoring leukocyte counts and preventing leukopenia are essential for successful treatment with clozapine for refractory schizophrenia. These medicines may be a potential option for preventing clozapine-induced leukopenia.
尽管氯氮平是治疗难治性精神分裂症患者的最佳药物，但该药物具有诸如白细胞减少等有害副作用。已知腺嘌呤和千金藤素对辐射或药物引起的白细胞减少有效。此外，中药人参养荣汤可增强粒细胞 - 巨噬细胞集落刺激因子的产生。因此，这些药物可能对氯氮平引起的白细胞减少有用。
一名21岁的精神分裂症女性因开始氯氮平治疗而住院。尽管同时使用了具有增加白细胞活性的腺嘌呤、千金藤素和碳酸锂，但氯氮平治疗开始后白细胞计数仍出现下降。额外给予人参养荣汤可增加白细胞计数，从而预防了白细胞减少的发生。
这是首例同时使用腺嘌呤、千金藤素和人参养荣汤显示出逆转氯氮平引起的白细胞减少效果的病例。监测白细胞计数并预防白细胞减少对于使用氯氮平成功治疗难治性精神分裂症至关重要。这些药物可能是预防氯氮平引起的白细胞减少的潜在选择。
