Denton Lauren, Kapuganti Amber, Kim Sarah
Behavioral Health Clinical Pharmacist, Duke Regional Hospital, Durham, North Carolina.
Psychiatrist, Duke Regional Hospital, Durham, North Carolina.
Ment Health Clin. 2023 Aug 7;13(4):190-192. doi: 10.9740/mhc.2023.08.190. eCollection 2023 Aug.
Clozapine carries a US boxed warning for severe neutropenia, and strict monitoring is required through the FDA's Risk Evaluation and Mitigation Strategy (REMS) program. Patients with confirmed diagnosis of COVID-19 are also at risk for neutropenia. For patients on clozapine, the diagnosis of this novel virus may require an increase in the frequency of scheduled ANC monitoring. A case report of moderate neutropenia following COVID-19 diagnosis that required an increase in the frequency of ANC monitoring in a patient on long-term clozapine treatment is discussed.
A 33-year-old white man with schizophrenia had been on clozapine for more than 2 years, with an ANC monitoring schedule once every 4 weeks. The patient was admitted to the hospital for worsening aggressive behavior. On day 11 of hospital admission, he tested positive for COVID-19. Five days following this diagnosis, the patient's ANC dropped from 2.2/L to 0.8/L. This decrease led to daily ANC labs and the clozapine regimen being held for 1 day. Throughout the patient's admission adjustments were made to the frequency of lab monitoring based on fluctuations in his ANC levels.
There have been limited case reports on patients receiving clozapine experiencing neutropenia following the diagnosis of COVID-19. To the authors knowledge, this is the first case report from the United States that specifically discusses the required changes to ANC monitoring.
Patients on clozapine who test positive for COVID-19 may be at an even greater risk for neutropenia, compared with clozapine patients without COVID-19. Increasing the frequency of ANC monitoring should be considered in the weeks following the diagnosis to ensure that clozapine treatment can be safely adjusted, or even discontinued.
氯氮平有美国黑框警告提示严重中性粒细胞减少，需要通过美国食品药品监督管理局（FDA）的风险评估与缓解策略（REMS）计划进行严格监测。确诊为新型冠状病毒肺炎（COVID-19）的患者也有中性粒细胞减少的风险。对于服用氯氮平的患者，这种新型病毒的诊断可能需要增加定期中性粒细胞绝对计数（ANC）监测的频率。本文讨论了1例COVID-19诊断后出现中度中性粒细胞减少的病例报告，该患者长期接受氯氮平治疗，需要增加ANC监测频率。
一名33岁患有精神分裂症的白人男性服用氯氮平超过2年，ANC监测计划为每4周一次。该患者因攻击行为恶化入院。入院第11天，他的COVID-19检测呈阳性。诊断后5天，患者的ANC从2.2/L降至0.8/L。这一降低导致每日进行ANC检测，氯氮平治疗方案暂停1天。在患者住院期间，根据其ANC水平的波动对实验室监测频率进行了调整。
关于服用氯氮平的患者在COVID-19诊断后出现中性粒细胞减少的病例报告有限。据作者所知，这是美国第一例专门讨论ANC监测所需变化的病例报告。
与未感染COVID-19的氯氮平患者相比，COVID-19检测呈阳性的氯氮平患者可能有更高的中性粒细胞减少风险。在诊断后的几周内，应考虑增加ANC监测频率，以确保氯氮平治疗能够安全调整，甚至停药。
