Li to augment Clozaril

[DebDynamite]

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In order not to hijack another thread currently on the board:
Whopper recently commented on Li augmentation with Clozaril.

I had an attending point out to me that there's a theory that Lithium is promoting WBC demargination, so that in reality the use of it to treat Clozaril induced agranulocytosis is actually just treating the lab value.

Note, he didn't say this is what's going on- he just pointed out the theory and stated, "...it leads one to wonder..."

What do you think about this?

 

[strangeglove]

From Paton et al., Psychiatric Bulletin (2005) 29: 186-188:

"Neutrophilia does not seem to be clearly dose-related (Lapierre & Stewart, 1980; Carmen et al, 1993) although a minimum lithium serum level of 0.4 mmol/l may be required (Blier et al, 1998). The mechanism is not completely understood: direct stem cell stimulation (Kramlinger & Post, 1990), stimulation of granulocyte-macrophage colony-stimulating factor (GM-CSF; Ozdemir et al, 1994), stimulation of cytokines (Phiel & Klein, 2001) and demargination (Small et al, 2003) have all been suggested."

So, perhaps not just demargination.

 

[DebDynamite]

Yes, perhaps not. I found the same article last night after posting here.

Here is the link:

http://pb.rcpsych.org/cgi/content/full/29/5/186


Wonder if anyone with significant clinical experience with this will comment?

 

[whopper]

Your attending brought up a good point, and its in the article mentioned. It is not protection against agranulocytosis (or possibly not an end all be all protection).

One could also try a colony stimulating factor.

There is also the theory that the reason why clozaril causes agranulocytosis is because it reduces the effect of myeloperoxidase. Thus came a theory that antioxidants may decrease the effect of the agranulocytosis (because myeloperoxidase is an antioxidant). However no one has tested the theory that antioxidants may at least mitigate the agranulocytic effects of Clozaril except in animals which showed no benefit.