Review Question - QID 107496

This patient presented with treatment-resistant schizophrenia and was prescribed clozapine. After returning for follow-up he was found to have agranulocytosis with an Absolute Neutrophil Count (ANC) of approximately 1400.

Clozapine is an atypical antipsychotic that is the only approved drug for treatment-resistant schizophrenia. It is not considered a first-line drug due to the ~1% risk of developing agranulocytosis. Other important side effects of clozapine include: myocarditis, sialorrhea, orthostatic hypotension, and seizures. Patients taking clozapine should have blood counts taken weekly for the first six months with less frequent intervals afterwards.

Muench and Hamer discuss the side effects of typical and atypical antipsychotics. clozapine is commonly associated with metabolic syndrome and the most serious side effect being agranulocytosis. Should the ANC drop below 1500 in a person taking clozapine, the drug should be stopped immediately.

Meltzer discusses the advantages and side effects of clozapine. Patients taking clozapine have decreased risk of suicide, relapse and movement issues, additionally those taking the drug have a higher quality of life. The risk of agraunlocytosis is highest in the first six months of therapy and patients should undergo frequent evaluation of blood counts. After six months of therapy the mortality risk of agranulocytosis is similar to that of other drugs.

Incorrect Answers:
Answer 1: Patients on the atypical antipsychotic olanzapine should be followed for the development of metabolic syndrome and diabetes.
Answer 2: Halperidol is a high potency typical antipsychotic that is known for its movement side effects (dystonia, akathisia, pseuodo-parkinsonism, tardive dyskinesia)
Answer 3: Chlorpromazine is a low potency typical antipsychotic know for its anticholinergic effects.
Answer 5: Lurasidone is a newer atypical antipsychotic which is becoming popular as it is weight neutral.