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Low-Dose Lithium for Long-Term Treatment of Clozapine- Induced Neutropenia: A Case Series

[ Vol. 8 , Issue. 2 ]


Muhammad R. Baig*   Pages 155 - 158 ( 4 )


Background: Treatment-resistant psychosis makes schizophrenia a disabling and costly illness. Clozapine is an effective treatment for treatment-resistant psychosis, though it is underutilized mainly due to prescribing providers’ fear of a serious yet uncommon complication, clozapine-induced neutropenia. Clozapine-induced neutropenia predisposes patients to potentially life-threatening infections leading prescribers to stop use when blood counts start to drop even well above the recommended cut-off point. Colonystimulating factors are effective options for reducing risk and duration of neutropeniarelated events though they add a significant cost burden to the patient and healthcare system. There is a great need for feasible and cost-effective pharmacotherapies in the mental health care setting for the management of clozapine-induced neutropenia.

Objective: We evaluated adjunctive use of lithium when prescribed at a low-dose to stabilize dropping blood count in patients receiving clozapine for treatment-resistant psychosis.

Methods & Results: A case series analysis of three patients who were followed in a mental health outpatient clinic for the management of schizophrenia. Blood counts of all the patients were stabilized by low-dose lithium treatment and continued to receive long term treatment of clozapine.

Conclusion: Results suggest low-dose lithium as a feasible and cost-effective pharmacotherapeutic option enabling the continuation of clozapine, an effective treatment for treatment-resistant psychosis.


Clozapine-induced neutropenia, long-term stabilization, psychopharmacotherapy, treatment resistant psychosis, blood count, schizophrenia.


Mental Health, South Texas Veterans Health Care System, San Antonio, Tx

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