Clozapine is commonly associated with hematological side effects. However, little research is available on the impact of adding other psychotropic medication on inducing blood dyscrasias.

The aim of the study was to explore the impact of associating psychotropic medication to clozapine in producing hematological abnormalities.

Our study was a longitudinal, retrospective chart review of adult psychiatric patients receiving clozapine treatment at our clozapine consultation between January 2000 and September 2020.

Our sample consisted of 15 women (23.5%) and 49 men (76.5%), mean age was 41.34 ±9.32 years. Polypharmacy was found in 70.3% of the cases. Association of clozapine to other psychotropic agents was found in 67.2% of the cases. Most prescribed add-on medication was valproic acid in 27 cases, benzodiazepines in 21 cases, promethazine and hydroxyzine in 16 cases, lithium in 8 cases and haloperidol in 6 cases. We found blood dyscrasias in 21 patients (32.8%). Hematological abnormalities were as follow: 2 cases of agranulocytosis, 8 cases of neutropenia, 13 cases of thrombocytopenia, 5 cases of leukocytosis, 5 cases of eosinophilia and 3 cases of anemia. In our sample we did not find a significant association between psychotropic polypharmacy and blood dyscrasias.

Many psychiatric patients on clozapine require polypharmacy to better stabilize their condition. Such co prescriptions may carry the risk of inducing more side effects especially blood dyscrasias. In our study, we did not find a significant association between psychotropic medication added to clozapine and hematological abnormalities. But further research is warranted to better explore this association.

No significant relationships.

Clozapine is commonly associated with adverse hematological outcomes. However, incidence of blood dyscrasias in the north African population is scarce.

The aim of this study was to assess the incidence of hematological side effects in a Tunisian sample of clozapine treated patients.

We conducted a retrospective longitudinal chart review of 64 patients on clozapine enrolled in our clozapine consultation between January 1, 2000 and September 2020.

Our sample consisted of 15 women (23.5%) and 49 men (76.5%), mean age was 41.34 ±9.32 years. Patients were diagnosed with schizophrenia in 70.3% of the cases, 7 (10.9%) had a bipolar disorder and 12 (18.8%) had a schizoaffective disorder.We found blood dyscrasias in 21 patients (32.8%). Hematological abnormalities were as follow: 2 cases of agranulocytosis, 8 cases of neutropenia, 13 cases of thrombocytopenia, 5 cases of leukocytosis, 5 cases of eosinophilia and 3 cases of anemia. The incidence rate of hematological side effects was 0.1 case/year- person. The mean clozapine dose at the time of onset of the hematological side effect was 309.52 mg/day(range 25-600 mg/day).The median duration of clozapine treatment prior to developing hematological side effects was 119.71±126.52 days.Clozapine discontinuation was decided in 11 cases due to hematological side effects and reintroduced in 9 cases after normalization of blood count.

This study emphasis on the importance of a regular long-term monitoring of blood count to ensure early detection of hematological side effects.

No significant relationships.