Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review
Background: Clozapine is the only Food and Drug Administration (FDA) and National Institute for Care and Excellence (NICE) approved drug for treatment-resistant schizophrenia (TRS). Its potentially life-threatening haematological side effects of neutropaenia and agranulocytosis mandate rigorous moni...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2023-10-01
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| Series: | South African Journal of Psychiatry |
| Subjects: | |
| Online Access: | https://sajp.org.za/index.php/sajp/article/view/2039 |
| _version_ | 1797641257547202560 |
|---|---|
| author | Michelle V. Daniels Suvira Ramlall |
| author_facet | Michelle V. Daniels Suvira Ramlall |
| author_sort | Michelle V. Daniels |
| collection | DOAJ |
| description | Background: Clozapine is the only Food and Drug Administration (FDA) and National Institute for Care and Excellence (NICE) approved drug for treatment-resistant schizophrenia (TRS). Its potentially life-threatening haematological side effects of neutropaenia and agranulocytosis mandate rigorous monitoring of neutrophil counts, presenting unique, Third-World population challenges.
Aim: To describe the Clozapine white blood cell monitoring practice and outcomes in a local psychiatric hospital.
Setting: At a specialist Psychiatry unit in Durban, KwaZulu-Natal, which follows a modified algorithm of the South African Standard Treatment Guidelines for Clozapine monitoring.
Methods: A retrospective chart review composed of 120 patients on Clozapine treatment from 01 July 2018–31 December 2020. Demographic and clinical information was captured in a Redcap database. Descriptive statistics using categorical variables were used.
Results: The study population was from a low socioeconomic background, with low levels of education and employment. A baseline neutrophil count was recorded in 58 files (48.3%). Clozapine was stopped in 6 out of the 120 patients due to ‘neutropaenia’ (absolute neutrophil counts ranging from 1.18 to 1.6); none developed agranulocytosis. Their duration of Clozapine treatment ranged from 2 weeks–15 years.
Conclusion: Haematological monitoring frequency and documentation of patients receiving Clozapine were not in compliance with the hospital’s adapted guidelines and may have resulted in the termination of treatment before true neutropaenia developed. Patients developed neutropaenia at low doses of Clozapine and after many years of treatment.
Contribution: These results suggest local Clozapine monitoring guidelines should be more strictly adhered to. |
| first_indexed | 2024-03-11T13:42:57Z |
| format | Article |
| id | doaj.art-0cc0e6fd2bc944daa55ed6257a7a3ccd |
| institution | Directory Open Access Journal |
| issn | 1608-9685 2078-6786 |
| language | English |
| last_indexed | 2024-03-11T13:42:57Z |
| publishDate | 2023-10-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Journal of Psychiatry |
| spelling | doaj.art-0cc0e6fd2bc944daa55ed6257a7a3ccd2023-11-02T11:07:33ZengAOSISSouth African Journal of Psychiatry1608-96852078-67862023-10-01290e1e710.4102/sajpsychiatry.v29i0.2039667Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart reviewMichelle V. Daniels0Suvira Ramlall1Department of Psychiatry, Faculty of Health Sciences, University of KwaZulu Natal, DurbanDepartment of Psychiatry, Faculty of Health Sciences, University of KwaZulu Natal, DurbanBackground: Clozapine is the only Food and Drug Administration (FDA) and National Institute for Care and Excellence (NICE) approved drug for treatment-resistant schizophrenia (TRS). Its potentially life-threatening haematological side effects of neutropaenia and agranulocytosis mandate rigorous monitoring of neutrophil counts, presenting unique, Third-World population challenges. Aim: To describe the Clozapine white blood cell monitoring practice and outcomes in a local psychiatric hospital. Setting: At a specialist Psychiatry unit in Durban, KwaZulu-Natal, which follows a modified algorithm of the South African Standard Treatment Guidelines for Clozapine monitoring. Methods: A retrospective chart review composed of 120 patients on Clozapine treatment from 01 July 2018–31 December 2020. Demographic and clinical information was captured in a Redcap database. Descriptive statistics using categorical variables were used. Results: The study population was from a low socioeconomic background, with low levels of education and employment. A baseline neutrophil count was recorded in 58 files (48.3%). Clozapine was stopped in 6 out of the 120 patients due to ‘neutropaenia’ (absolute neutrophil counts ranging from 1.18 to 1.6); none developed agranulocytosis. Their duration of Clozapine treatment ranged from 2 weeks–15 years. Conclusion: Haematological monitoring frequency and documentation of patients receiving Clozapine were not in compliance with the hospital’s adapted guidelines and may have resulted in the termination of treatment before true neutropaenia developed. Patients developed neutropaenia at low doses of Clozapine and after many years of treatment. Contribution: These results suggest local Clozapine monitoring guidelines should be more strictly adhered to.https://sajp.org.za/index.php/sajp/article/view/2039clozapine monitoring guidelinesclozapine monitoring guidelines in south africatreatment-resistant schizophreniabenign ethnic neutropaeniabenign familial neutropaeniaclozapine-induced neutropaeniaclozapine-induced agranulocytosis |
| spellingShingle | Michelle V. Daniels Suvira Ramlall Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review South African Journal of Psychiatry clozapine monitoring guidelines clozapine monitoring guidelines in south africa treatment-resistant schizophrenia benign ethnic neutropaenia benign familial neutropaenia clozapine-induced neutropaenia clozapine-induced agranulocytosis |
| title | Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review |
| title_full | Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review |
| title_fullStr | Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review |
| title_full_unstemmed | Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review |
| title_short | Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review |
| title_sort | clozapine monitoring at a specialised psychiatric hospital a retrospective chart review |
| topic | clozapine monitoring guidelines clozapine monitoring guidelines in south africa treatment-resistant schizophrenia benign ethnic neutropaenia benign familial neutropaenia clozapine-induced neutropaenia clozapine-induced agranulocytosis |
| url | https://sajp.org.za/index.php/sajp/article/view/2039 |
| work_keys_str_mv | AT michellevdaniels clozapinemonitoringataspecialisedpsychiatrichospitalaretrospectivechartreview AT suviraramlall clozapinemonitoringataspecialisedpsychiatrichospitalaretrospectivechartreview |