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International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 199–202 | Cite as

Successful clozapine continuation during chemotherapy for the treatment of malignancy: a case report

  • Marloes R. Overbeeke
  • Marieke M. Beex-OosterhuisEmail author
  • Ellen Graveland
  • Jannie N. den Hoed-van Wijk
  • Arthur R. Van Gool
Case Report

Abstract

Case

The need for chemotherapy treatment in a cancer patient who uses clozapine raises a clinical dilemma because both therapies can cause agranulocytosis. A 45-year-old male diagnosed with schizophrenia used clozapine together with zuclopenthixol for more than 15 years. Non-Hodgkin’s lymphoma was treated with chemotherapy twice, and clozapine was continued during both courses of chemotherapy. Agranulocytosis did not occur during the first treatment. During the second treatment, agranulocytosis occurred, but was attributed to chemotherapy, and blood counts recovered spontaneously. Successful concomitant use of clozapine and cancer chemotherapy is based on a limited number of case reports. However, two case reports describe persistent neutropenia or agranulocytosis, possibly related to this combination.

Conclusion

Clozapine should only be continued during cancer chemotherapy if favoured by the risk-to-benefit ratio.

Keywords

Agranulocytosis Chemotherapy Clozapine Constipation Malignancy Non-Hodgkin lymphoma 

Notes

Acknowledgments

Anne-Marie Doppen is kindly acknowledged for providing the drug information during chemotherapeutic treatment.

Funding

None.

Conflicts of interest

The authors report no conflicts of interest.

References

  1. 1.
    Grover S, Hazari N, Chakrabarti S, Avasthi A. Delay in initiation of clozapine: a retrospective study from a tertiary care hospital in North India. Psychiatry Res. 2015;226(1):181–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Schulte P. Risk of clozapine-associated agranulocytosis and mandatory white blood cell monitoring. Ann Pharmacother. 2006;40(4):683–8.CrossRefPubMedGoogle Scholar
  3. 3.
    The Dutch Medicines Evaluation Board. Summary of Product Characteristics Leponex. [updated 2015 April 19; cited 2015 June 1] Available from: http://db.cbg-meb.nl/IB-teksten/h10460.pdf.
  4. 4.
    Cunningham NT, Dennis N, Dattilo W, Hunt M, Bradford DW. Continuation of clozapine during chemotherapy: a case report and review of literature. Psychosomatics. 2014;55(6):673–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Sankaranarayanan A, Mulchandani M, Tirupati S. Clozapine, cancer chemotherapy and neutropenia—dilemmas in management. Psychiatr Danub. 2013;25(4):419–22.PubMedGoogle Scholar
  6. 6.
    Usta NG, Poyraz CA, Aktan M, Duran A. Clozapine treatment of refractory schizophrenia during essential chemotherapy: a case study and mini review of a clinical dilemma. Ther Adv Psychopharmacol. 2014;4(6):276–81.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Deodhar JK, Prabhash K, Agarwal JP, Chaturvedi P. Clozapine and cancer treatment: adding to the experience and evidence. Indian J Psychiatry. 2014;56(2):191–3.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Monga V, Broucek M, Amani M, Ramaswamy S. Clozapine and concomitant chemotherapy in a patient with schizophrenia and new onset esophageal cancer. Psychooncology. 2015;24(8):971–2.CrossRefPubMedGoogle Scholar
  9. 9.
    Goulet K, Grignon S. Case report: clozapine given in the context of chemotherapy for lung cancer. Psychooncology. 2008;17(5):512–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Rosenstock J. Clozapine therapy during cancer treatment. Am J Psychiatry. 2004;161(1):175.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Department of Pharmaceutical SciencesUniversity of UtrechtUtrechtThe Netherlands
  2. 2.Department of Hospital PharmacyAlbert Schweitzer HospitalDordrechtThe Netherlands
  3. 3.Yulius Mental Health InstitutionDordrechtThe Netherlands

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