Clinical Guidance: Rechallenge of the Clozapine Patient With Eosinophilia
Patients who develop eosinophilia during clozapine treatment are at risk for organ damage, which occurs in patients with idiopathic eosinophilia, in which eosinophils are more than 1.5×109/liter for more than 6 months. A patient who became actively suicidal without clozapine but who had previously had eosinophilia during clozapine treatment prompted an attempted rechallenge by Roberts et al. (p. 1147). Treatment parameters for the slow titration of clozapine included maintaining eosinophils at less than 1.5×109/liter and monitoring for possible end organ involvement with ECG, echocardiogram, serum troponin, amylase, lipase, and pulmonary and renal function tests. The patient's eosinophils increased to a peak of 1.2×109/liter as the clozapine dose was increased to 150 mg/day during the first 4 weeks. Thereafter, the eosinophils decreased with clozapine maintained at the same dose. As eosinophils continued to decrease, he could eventually receive doses up to 400 mg/day.