Zyprexa-induced neutropenia

Discussion in 'Psychiatry' started by Anasazi23, Dec 1, 2005.

  1. Anasazi23

    Anasazi23 Your Digital Ruler
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    How often have you seen neutropenia in pt's taking Zyprexa?

    I know Zyprexa' been associated with leukopenia, granulocytopenia, neutropenia, pancytopenia and anemia, but is this common in others' experiences?

    Makes sense why it works so well. Too bad it's under such attack. At my hospital now, the computer gives you a warning, and refuses to let any doctor even prescribe it if they're not a psychaitrist in the psychiatry department or with psychiatry attending approval. Of course, it's not for the above reasons, but you get my point.
     
  2. DrIng

    DrIng Senior Member
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    It's used really commonly in Australia and I've never had a patient with neutropenia on it, the main and obvious problem is the weight gain and glucose disregulation...
     
  3. psychattending

    psychattending Program Director
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    Olanzapine-induced neutropenia is pretty rare. I'm at a big academic hospital and have not heard about a case. There are only about 10 case reports in the literature. I would think that the rate is very low and along the lines of that seen with other antipsychotics (except clozapine, of course).
     
  4. Anasazi23

    Anasazi23 Your Digital Ruler
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    I just saw my third case in two years. Admittedly, the most recent case had other complicating factors (gout, etc).

    Anyay, there is this reported side effect. I'll try to post some of it here when I get more time.

    Any other opinions?
     
  5. Anasazi23

    Anasazi23 Your Digital Ruler
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    Just a quick google search yielded:

    Canadian Adverse Reaction Newsletter
    Volume 10 · Number 3 · July 2000

    "Hematological reactions

    Six reports of hematological reactions were previously reviewed in this newsletter in 1998.2 Since then 5 additional cases have been received. The following is a summary of all 11 cases. The reports described leukopenia, granulocytopenia, neutropenia, pancytopenia or anemia in patients taking olanzapine. The reported onset of neutropenia or granulocytopenia varied from 2 days to 6 months, with a recovery period of 1 day to 3 months. In 5 of the 11 cases the patient had a history of similar problems when taking the chemically related drug clozapine. A history of clozapine-induced leukopenia may be a risk factor for hematological reactions to olanzapine.3 However, some patients have been able to tolerate olanzapine despite a history of clozapine-related neutropenia.4,5 As well, it is not clear whether olanzapine can delay the recovery of clozapine-induced leukopenia, since the recovery time is variable.6"

    It appears as though with great effects come great side effects.
     
  6. Milo

    Milo Senior Member
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    Anasazi induced neutropenia?
     
  7. Anasazi23

    Anasazi23 Your Digital Ruler
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    Maybe you're on to something.

    I've been known to cause pancytopenia on more than one occasion.

    :smuggrin:
     
  8. batman123

    batman123 Senior Member
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    I'm not too sure about Zyprexa.. now Clozaril... that's another story
     
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  9. Anasazi23

    Anasazi23 Your Digital Ruler
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    The medications are similar...hence the similar reactions.
     
  10. Milo

    Milo Senior Member
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    Zyprexa = Clozaril Lite

    Same great taste, less filling.
     
  11. Anasazi23

    Anasazi23 Your Digital Ruler
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    That's kinda funny
    :laugh:


    A semi-serious question:
    If you were psychotic, would you rather be obese or have chronic serious infections?
     
  12. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Why choose, when you can have both, with incessant drooling too!
     
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  13. Anasazi23

    Anasazi23 Your Digital Ruler
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    I recently saw a patient who was a semi-frequent flyer on the street. She's been out of the hospital since she started Clozaril. However, I didn't recognize her at first because she gained about 60 lbs. She says she feels better...but man, what a trade-off.

    She's being supplemented with topirimate. But as we know, that research is still up in the air. Personally, it seems to work for many, but not all in this situation.
     
  14. mollywobbles

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    bring on the chronic infections...you weren't talking to me, were you?

    i'd rather be ill than fat. and then if being ill took it's toll, then maybe i'd switch to being fat.
     
  15. Anasazi23

    Anasazi23 Your Digital Ruler
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    I think I agree with you. If I became fat, that would just make me more psychotic. Then again, that's easy to say while we're not sitting in a hospital bed, hooked up to Zosyn, with rigors being forced to hear Jerry Springer all day on the neighbor's television.
     
  16. mollywobbles

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    what, you no like the springer? just kidding; my god he's awful.

    we walked into a comatose patient's room, and springer was on. the resident was checking something. the fellow was watching springer. he absent mindedly said to me, "two chicks fighting is soo hot".
     
  17. Hi, I'm new to these forums, and have a unique perspective being a) a lawyer not a doctor b) having been on a variety of psychotropics including clozaril (clozapine in Australia) and now olanzapine, and c) a patient with severe bipolar and anxiety. I joined these forums specifically to comment on the previous exchange between Mollywobbles and Anasazi23. It kind of made me sick. It showed a stunning lack of compassion. For a p doc or medical student to say that they'd rather be "ill than fat" or that "being fat would make them psychotic" shows that they don't understand the kind of choices that psych patients make ALL the time because pretty much ALL the drugs give you something - some kind of EPS - tardive dystonia anyone? or perhaps you want some Parkinsonionism? or to have tremors? or leukopenia or throw up all the time, or get really really fat?? I have had all that and more. And usually these drugs don't fix every thing, they just help some, so you STILL feel **** - and you can't fit into any of your clothes or drive your car.

    It might seem funny from where you're standing, but from where I am, I lost my sense of humour about all this a long time ago. (and yes, kick me off the boards.)
     
  18. Ceke2002

    Ceke2002 Purveyor of Strange
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    Did you ever stop and think that Doctors may sometimes need to use humour in this way to blow off steam or risk going round the bend themselves with some of the tragedy and sh!t they have to deal with? This is a forum for Doctors, we, as non medical professionals, don't get to tell someone how to behave in their own house.
     
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  19. hamstergang

    hamstergang may or may not contain hamsters
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    Sure, but this thread was nearly a decade old. It could have stayed dead with basically no one reading it anymore until you brought it back to life.
     
  20. whopper

    whopper Former jolly good fellow
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    It turns out that any of the "apines" can cause neutropenia including the one we all know about-clozapine but also mirtazapine, quietapine, loxapine, olanzapine, etc.

    Clozapine is the big offender. The other ones likely will not cause any difference but realistically could cause a sub-clinical neutropenia drop that's not so significant in an otherwise healthy person.

    A problem I've thought about is that mirtazapine is often given to chemo-patients because it helps them sleep and it spikes appetite. Should it be given that at this time their immune systems could be depleted by the chemo and they need their systems working to fight off the cancer? Should we be giving marinol instead?
     
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  21. Shikima

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    Would you still get the same 5-HT benefit from undergoing chemo - much like receiver Hep. C Tx?
     
  22. whopper

    whopper Former jolly good fellow
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    The neutrophil drop is also of concern in patients on multiple meds. You usually don't see cases like this unless working in a state hospital but in that setting it's usual to get a patient needing polypharmacy. While I worked in the state hospital it was usual to have 20% of your patients on clozapine and many of the rest required at least 4 meds. It was an odd setting. I had people on extensive polypharmacy despite that I usually see such regimens as a result of know-nothing psychiatrists (polypharmacy should be the exception, not the norm), but also quite a few patients on nothing because many people in the units were malingering and misdiagnosed.

    Remember the state hospital is the place where usual psych units send their patients if they don't get better within a few weeks. These patients are usually treatment-resistant.

    If I couldn't tell what was going on with the patient I usually didn't medicate them for around 3-4 days. By then I almost always had it figured out. The people needing the 3-4 days was less than 1/2 of the patients because I usually had enough information on the first interview to be confident of what was going on. You could afford to do that in state hospitals. IMHO this leads to less hospitalization over all because it weeds out the people that really aren't mentally ill to the point where they need meds and it produces a record of a doctor seeing them while not medicated. The current system of medicating them on day 1 IMHO just leads to too much misdiagnosis and frequent flyers that aren't benefiting from hospitalization.

    I think I'm missing something with your post. Serotonin benefit from the chemo?

    Another thing to factor and maybe an oncologist knows more---This aspect usually isn't taught to PCPs or heck psychiatrists, a theory as to why patients with cancer lose weight is because cancer cells often times release TNF into the blood and this kills appetite. There is a theory that this is actually protective against cancer because the nutrition will make the cancer cells divide more like crazy while the non-cancerous cells in the body tend to not divide as much. Ergo less eating could actually be a good thing.

    So that said, should we be striving to make the person eat more with mirtazapine if on chemo? Of course if they're severely underweight they'll need more nutrition, but what if the person is overweight?
     
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    #22 whopper, Jul 7, 2015
    Last edited: Jul 7, 2015
  23. Shikima

    Physician 10+ Year Member

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    Sorry, I was typing too quickly and I knew what I was thinking, just didn't come out.

    I was thinking that we often screen/treat Hep. C treatment due to the higher incidence in the development of depression. With that in mind, could there be an added benefit in improving mood/well-being with the addition of 5-HT from Remeron compared to Marinol while going through chemotherapy - I'm not aware of any studies linking/correlating depression with chemotherapy such as treatment for Hep. C has been documented, but hypothizing that the demoralizing process of going through cancer treatment itself is recieving a boost by using Remeron.
     
  24. whopper

    whopper Former jolly good fellow
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    That's another interesting question, but why give mirtazapine (Remeron) and not another antidepressant? The problem I got with the mirtazapine is that it could lower the immune response against cancer given that it could subclinically (or worse) lower neutrophils. Further, the extra eating might not be a good thing.

    The Marinol suggestion I have is based on it improving appetite, reducing nausea, and giving some possible euphoria during the chemotherapy and it being an alternative because it might not reduce immune response (to my knowledge-I could be wrong).
     
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