Background: Treatment-resistant psychosis makes schizophrenia a disabling
and costly illness. Clozapine is an effective treatment for treatment-resistant psychosis,
though it is underutilized mainly due to prescribing providers’ fear of a serious yet uncommon
complication, clozapine-induced neutropenia. Clozapine-induced neutropenia
predisposes patients to potentially life-threatening infections leading prescribers to stop use
when blood counts start to drop even well above the recommended cut-off point. Colonystimulating
factors are effective options for reducing risk and duration of neutropeniarelated
events although they add a significant cost burden to the patient and healthcare system.
There is a great need for feasible and cost-effective pharmacotherapies in the mental
health care setting for the management of clozapine-induced neutropenia.
Objective: We evaluated adjunctive use of lithium when prescribed at a low-dose to stabilize
dropping blood count in patients receiving clozapine for treatment-resistant psychosis.
Method & Results: A case series analysis of three patients was followed in a mental health
outpatient clinic for the management of schizophrenia. Blood counts of all the patients
were stabilized by low-dose lithium treatment and continued to receive long term treatment
Conclusion: Results suggest low-dose lithium as a feasible and cost-effective pharmacotherapeutic
option enabling the continuation of clozapine, an effective treatment for