From the FDA Drug Label
- 10 Leukopenia, Neutropenia, and Agranulocytosis In clinical trials and/or postmarketing experience, events of leukopenia and neutropenia have been reported temporally related to antipsychotic agents, including aripiprazole. Agranulocytosis has also been reported
The FDA drug label does not answer the question.
From the Research
Quetiapine (Seroquel) generally has the lowest risk of causing neutropenia or agranulocytosis among antipsychotic medications. While all antipsychotics carry some risk of hematological adverse effects, quetiapine has demonstrated a more favorable safety profile in this regard compared to other options, as supported by a recent study 1. Clozapine, by contrast, carries the highest risk and requires mandatory blood monitoring through the REMS program. Other second-generation (atypical) antipsychotics like olanzapine, risperidone, and aripiprazole also have relatively low risks of neutropenia, though slightly higher than quetiapine.
The mechanism behind antipsychotic-induced neutropenia involves direct bone marrow toxicity and immune-mediated destruction of neutrophil precursors. Despite quetiapine's better safety profile, clinicians should still monitor complete blood counts periodically in patients on any antipsychotic, especially during the first few months of treatment when the risk is highest, as highlighted in a study 2. Patients should be educated about symptoms of neutropenia such as fever, sore throat, and infections, and advised to seek immediate medical attention if these develop.
Some studies have reported cases of neutropenia associated with various antipsychotics, including olanzapine 3 and clozapine 4. However, a meta-analysis 4 found that the risk of neutropenia associated with clozapine was not significantly higher than with other antipsychotic medications. A more recent study 1 found that quetiapine had a lower incidence of neutropenia compared to other antipsychotics, including olanzapine and clozapine.
Key points to consider when prescribing antipsychotics include:
- Monitoring complete blood counts periodically, especially during the first few months of treatment
- Educating patients about symptoms of neutropenia and the importance of seeking immediate medical attention if these develop
- Considering the risk of neutropenia when selecting an antipsychotic medication, with quetiapine generally having the lowest risk
- Being aware of the potential for direct bone marrow toxicity and immune-mediated destruction of neutrophil precursors as mechanisms behind antipsychotic-induced neutropenia.