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Elevated clozapine levels associated with infection: A systematic review
Scott R Clark1, Nicola S Warren2, Gajin Kim1
1University of Adelaide, Department of Psychiatry, Adelaide, SA 5005, Australia.
Schizophrenia Research
|April 11, 2017
Summary
Infections can increase clozapine levels, leading to adverse effects like sedation in schizophrenia patients. Monitoring clozapine levels during infection is crucial for patient safety.
Area of Science:
- Pharmacology
- Infectious Diseases
- Psychiatry
Background:
- Clozapine is a vital antipsychotic for treatment-refractory schizophrenia.
- Emerging evidence links infections to elevated clozapine levels and adverse events.
Purpose of the Study:
- To systematically review and clarify the relationship between infection and elevated clozapine levels.
- To analyze associated adverse outcomes and clinical presentations.
Main Methods:
- Systematic review of published case reports from PubMed and Embase.
- Inclusion of 8 new Australian cases.
- Extraction of demographic, clinical, laboratory, and outcome data.
Main Results:
- 40 cases identified linking infection to elevated clozapine levels.
- Respiratory infections were most common.
- Adverse events, primarily sedation, occurred with raised clozapine levels; signs of infection were often masked.
Conclusions:
- The interplay between infection, clozapine levels, and adverse events is complex.
- Essential to monitor clozapine levels during infection-related hospitalizations.
- Consider gradual clozapine dose reduction to mitigate dose-related side effects.
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