CLOZAPINE TREATMENT IN DENMARK - CONCOMITANT PSYCHOTROPIC MEDICATION AND HEMATOLOGIC MONITORING IN A SYSTEM WITH LIBERAL USAGE PRACTICES

Background: Clozapine has been utilized in Denmark since the early 197 0s. This study examines doses, concomitant psychotropics, and leukocyt e counts. Method: All psychiatric hospitals in Denmark were asked for copies of all their clozapine monitoring forms, which were then person ally reviewed by the authors. Results: Forms from 656 patients were co llected from 32 hospitals. The male/female ratio was 2/1; the median a ge, 38 years (range, 18-80). Thirty-five percent received concomitant antipsychotics, 28% benzodiazepines, 19% anticholinergics, 11% antidep ressants, 8% antiepileptics, (carbamazepine, valproate, and phenobarbi tal), and 2% lithium. While there were no gender differences with resp ect to concurrent psychotropics, women received lower doses of clozapi ne than men (median dose, women 300 mg/day and men 400 mg/day, p < .02 ). Ten percent had had a neutrophil count < 2000/mu L (3.2% < 1500/mu L). Five percent had repeated neutrophil counts < 2000/mu L (1.5% < 15 00/mu L). There were two cases of agranulocytosis; both patients fully recovered upon withdrawal of clozapine. Clozapine was discontinued be cause of hematologic abnormalities in only five other cases (0.8%). Co nclusion: While use of concomitant psychotropics during clozapine trea tment should be limited because of an increased risk of complications, a totally restrictive policy might deprive certain patients of the be nefits of clozapine treatment. There appears to be a benign form of gr anulocytopenia that does not always necessitate discontinuation, provi ded there is close follow-up.