BMJ Case Reports 2013; doi:10.1136/bcr-2012-007172

Successful rechallenge with clozapine following ‘red alert’

  1. John Rees
  1. General Adult Psychiatry, Parklands Hospital, Basingstoke, Hampshire, UK
  1. Correspondence to Dr Thelma K Toni-Uebari, thelma2{at}


A case is presented of a 23-year-old lady with treatment-resistant schizoaffective disorder who had responded well to treatment with clozapine. Fifteen months after satisfactory use of clozapine she had ‘red alerts’ from routine haematological monitoring indicating neutropenia. Clozapine was discontinued and she was admitted to the psychiatric hospital to manage the aftermath of discontinuing clozapine and start alternative treatment with other antipsychotics. Her mental health rapidly deteriorated. Adequate trials with amisulpride, haloperidol, olanzapine and flupenthixol decanoate yielded little improvement in her clinical state. After 9 months of non-response to other antipsychotic medications, she was rechallenged with clozapine, followed by improvement in her mental state. She was eventually discharged home after 14 months of hospitalisation in a stable mental state. She remained mentally stable in the community on clozapine for 18 months after rechallenge, with no further red alerts.

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