Risperidone引起之低白血球症及低嗜中性球症

Risperidone-induced Leukopenia and Neutropenia

目的：Risperidone 相較於其他精神科藥物造成血球低下的危險較低，我們在此報告一 位risperidone 引起低白血球及低嗜中性球的個案。病例報告：一位64 歲女性雙極性情感性 疾患第一型病人，過去曾服用多種精神藥物並無血液異常之過去史。在一次鬱期合併精神症 狀發作時，將藥物由quetiapine 換為risperidone 3.5 毫克／天四週後，常規血液檢查出現低 白血球症及低嗜中性球症，在將risperidone 增加至5 毫克後導致嗜中性球持續降低，停用 risperidone 12 天後血球數目恢復正常。結論：此為台灣第一例使用risperidone 可能引發低 白血球及低嗜中性球之個案報告，並且可能與劑量有關，臨床上仍需留意。

Background: Risperidone tends to have a lower risk of hematotoxicity. Here, we report a woman patient who developed risperidone-induced neutropenia. Case Report: A 64-year-old female patient with a diagnosis of bipolar disorder had received several antipsychotics previously, without a history of neutropenia or leucopenia. During a depressive episode with psychotic feature, she received risperidone 3.5 mg/day, lamotrigine 100 mg/day, and valproic acid 1,000 mg/day. Four weeks later, she had leukopenia (white blood cells [WBC]: 2900/mm3) and neutropenia (1,131/mm3) were noted in the regular laboratory test. Initially we suspected the lamotrigine was related to the neutropenia and discontinued it, and increased risperidone to 5 mg/day. Five days later, the neutrophil was further decreased to 1,015/mm3, so we discontinued risperidone and switched risperidone to 5 mg/day to sulpiride 600 mg/day. Twelve days later, the WBC and differential count were returned to normal limits. Conclusion: This is the fi rst report of risperidone-induced leukopenia and neutropenia in Taiwan.