Incidence and Risk Factors of Clozapine-Induced Neutropenia among Patients with Schizophrenia in Taif, Saudi Arabia.

Abstract

Background: Clozapine remains the most effective antipsychotic medication for treatment-resistant schizophrenia, but its use is limited by the risk of hematological side effects, particularly neutropenia. The present study aimed to determine the incidence and potential risk factors of neutropenia among patients receiving clozapine at a mental health hospital in Taif, Saudi Arabia.

Method: A retrospective analytical study was conducted using electronic medical records of Saudi adult patients diagnosed with schizophrenia initiated on clozapine during one-year. Demographic and clinical data were collected, including age, gender, presence of chronic medical conditions, starting dose, and treatment duration. The absolute neutrophil count (ANC) was used as the dependent variable. Statistical analysis was performed using the chi-square test, and results with p < 0.05 were considered significant.

Results: Eighty-nine patients were included (70 males and 19 females). Twenty participants (22.5%) developed neutropenia during clozapine therapy; most cases were mild. Neutropenia was less frequent among patients older than 30 years (20%) compared with younger patients (31.6%), but this difference was not statistically significant (p = 0.28). No significant associations were observed between neutropenia and gender, presence of chronic diseases, or starting dose. However, a significant relationship was found between treatment duration and the development of neutropenia (p < 0.001).

Conclusion: The incidence of clozapine-induced neutropenia among patients in this Saudi sample was higher than rates reported internationally, emphasizing the need for close hematological monitoring during the first months of therapy. Awareness among psychiatrists, pharmacists, and healthcare teams should be reinforced to ensure early detection and appropriate management.