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Need to bleed? Clozapine haematological monitoring approaches a time for change

Whiskey, Eromonaa,,b,,c; Dzahini, Olubankeb,,c; Ramsay, Rosalinda,,d; O’Flynn, Davide; Mijovic, Aleksandarf; Gaughran, Fionaa,,d; MacCabe, Jamesa,,d; Shergill, Sukhia,,d; Taylor, Davidb,,c

International Clinical Psychopharmacology: September 2019 - Volume 34 - Issue 5 - p 264–268
doi: 10.1097/YIC.0000000000000258
Case Reports

Regular haematological monitoring during clozapine treatment reduces the risk of complications and death from clozapine-related blood dyscrasias. However, many patients in the course of clozapine treatment develop neutropenia unrelated to drug treatment which leads to treatment discontinuation. The minimum haematological threshold allowed for the continuation of clozapine treatment was recently lowered in the US, but not in the UK. In this case series, we present four cases where lowering the haematological cut-off to that used in the US, allowed treatment continuation. Lowering the current UK threshold for clozapine cessation could avoid unnecessary interruptions in treatment with minimal impact on safety.

aNational Psychosis Service, South London and Maudsley NHS Foundation Trust

bPharmacy Department, South London & Maudsley NHS Foundation Trust

cInstitute of Pharmaceutical Science, King’s College

dDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

eDepartment of Rehabilitation Psychiatry, South London and Maudsley NHS Foundation Trust

fDepartment of Haematological Medicine, Kings College Hospital, London, UK

Received 20 February 2019 Accepted 25 February 2019

Correspondence to Eromona Whiskey, BPharm, Pharmacy Department, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, Tel: +44 2032285353; fax: +44 2032282337; e-mail:

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