Cited by 236Blood disorders and treatmentsHematological disorders and diagnosticsSchizophrenia research and treatment

Haematological toxicity of drugs used in psychiatry

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Flanagan, Robert J., Dunk, Louisa·2008·Human Psychopharmacology: Clinical and Experimental

Abstract

Almost all classes of psychotropic agents have been reported to cause blood dyscrasias. Mechanisms include direct toxic effects upon the bone marrow, the formation of antibodies against haematopoietic precursors or involve peripheral destruction of cells. Agranulocytosis is probably the most important drug-related blood dyscrasia. The mortality from drug-induced agranulocytosis is 5-10% in Western countries. The manifestations of agranulocytosis are secondary to infection. Aggressive treatment with intravenous broad-spectrum antimicrobials and bone marrow stimulants may be required. Of drugs encountered in psychiatry, antipsychotics including clozapine (risk of agranulocytosis approximately 0.8%, predominantly in the first year of treatment) and phenothiazines (chlorpromazine agranulocytosis risk approximately 0.13%), and antiepileptics (notably carbamazepine, neutropenia risk approximately 0.5%) are the most common causes of drug-related neutropenia/agranulocytosis. Drugs known to cause neutropenia should not be used concomitantly with other drugs known to cause this problem. High temperature and other indicators of possible infection should be looked for routinely during treatment. Clozapine is well known as a drug that can cause blood dyscrasias, but olanzapine and other atypicals may also cause similar problems. In addition to genetic factors, there are likely to be dose-related and immunological components to these phenomena. Important lessons have been learnt from the haematological monitoring that is necessary with clozapine and the monitoring has been very successful in preventing deaths related to clozapine-induced agranulocytosis. Continuing research into the mechanisms of drug-induced neutropenia and agranulocytosis may serve to further enhance the safe use not only of clozapine, but also of other agents.

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  1. Bhatt V, Saleem A. 2004. Review: drug-induced neutropeniapathophysiology, clinical features, and management. Ann Clin Lab Sci 34 : 131-137.

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Authors
Flanagan, R. J., & Dunk, L.
Affiliations
  • King's College Hospital NHS Foundation Trust (GB)
  • Leicester Royal Infirmary (GB)
Corresponding author
Flanagan, Robert J.
Venue
Human Psychopharmacology: Clinical and Experimental
Publisher
Wiley
Published
2007
Volume
23
Issue
S1
Pages
S27-S41
ISSN
  • 0885-6222 (ISSN-L)
  • 1099-1077
OpenAlex
W2081866209
Cited by
236
References
100
Citations by year
2026: 8 · 2025: 5 · 2024: 7 · 2023: 11 · 2022: 15 · 2021: 15 · 2020: 14 · 2019: 12 · 2018: 11 · 2017: 15 · 2016: 16 · 2015: 15 · 2014: 19 · 2013: 10 · 2012: 13
FWCI
1.15
Type
journal article
Language
en
Open access
Locations
  • Human Psychopharmacology Clinical and Experimental (publishedVersion)
  • PubMed (publishedVersion)
Funders
Eli Lilly and Company
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Blood disorders and treatments
  • Health Sciences › Medicine › Emergency Medicine › Hematological disorders and diagnostics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
drug-induced agranulocytosis, drug-induced neutropenia, clozapine, phenothiazines, chlorpromazine, carbamazepine, antipsychotic drugs, atypical antipsychotics, olanzapine, antiepileptic drugs, hematologic toxicity, myelosuppression, infection risk, hematological monitoring
MeSH terms
Animals, Mental Disorders, Hematologic Diseases, Humans, Psychotropic Drugs

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