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Failure of Induced Hypertension for Symptomatic Vasospasm in the Setting of Clozapine Therapy
Jonathan G Leung1, Sarah Nelson2, Sara Hocker3
1Department of Pharmacy, Mayo Clinic, 1216 2nd Street SW, Rochester, MN, 55902, USA. Leung.jonathan@mayo.edu.
Background:
Hemodynamic augmentation is utilized as a treatment in the setting of symptomatic cerebral vasospasm. This approach includes the use of vasopressors to induce hypertension with the aim of improved cerebral blood flow. Agents with potent alpha-1 antagonism properties, including clozapine, can inhibit or blunt the response of several vasopressor agents.
Methods:
Case report.
Results:
A 54-year-old schizophrenic male with an aneurysmal subarachnoid hemorrhage required hemodynamic augmentation in which several vasopressor trials resulted in no or poor response. The addition of epinephrine resulted in a decrease of mean arterial pressure. Vasopressin initiation demonstrated an immediate vasopressor effect.
Conclusions:
Vasopressors are an important treatment modality in symptomatic cerebral vasospasm. This case highlights the potential for clozapine to blunt the effects of vasopressors; or in the case of epinephrine, it causes a reversal effect. Vasopressin may be considered an agent of choice in patients who have recently taken clozapine and require hemodynamic augmentation.
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