Clozapine (lithium augmentation)

Question 1

Clozapine (lithium augmentation)

Answer 1

Lithium has been used successfully to raise the white cell count in people with neutropenia associated with clozapine use. Having said that lithium does not appear to protect against true clozapine-induced agranulocytosis.

Lithium increases the neutrophil count and total WCC both acutely and chronically. The magnitude of this effect is poorly quantified and although it does not seem does related a minimum serum level of 0.4 mmol/L is suggested. The mechanism is not completely understood: both stimulation of granulocyte-macrophage colony stimulating factor (GM-CSF) and demargination have been suggested. White cells are fully formed and function normally, and there is no ‘left shift’ (left shift describes immature white blood cells that are released from the marrow when there is a cause of marrow outpouring, typically due to infection).
Next question