Agranulocytosis with combination of paliperidone and clozapine: a case report

Abstract

Antipsychotics are the most common psychotropic drugs associated with blood dyscrasias, and clozapine is the most notably implicated when agranulocytosis occurs, although other antipsychotic agents can cause this serious side effect at different levels of risk. We present the case of a 26-year-old man with a treatment-resistant schizophrenia who developed agranulocytosis while under treatment with the combination of paliperidone and clozapine. We discuss the individual and combined implications of both antipsychotics in the development of agranulocytosis and the importance of haematological monitoring for combined antipsychotic treatment in general, and not only when clozapine is used. To the authors' knowledge this is the first report of agranulocytosis with the combination of clozapine and paliperidone.