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High-dose Clozapine Withdrawal: A Case Report and Timeline of a Single Potential Withdrawal Seizure
Megan K Skelly1,2,3, Tammie Lee Demler1,2,3, Claudia Lee1,2,3
1Drs. Skelly, Demler, and Lee are with the State University at Buffalo (SUNY) School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice in Buffalo, New York.
Abstract:
Clozapine, a second-generation antipsychotic (SGA), is known for its superior efficacy in the treatment of refractory schizophrenia. Clozapine's hallmark side effects are well-known, including, but not limited to, drug-induced seizures associated with daily goal doses greater than 600mg and rapid dose escalation, which can also contribute to significant risk of orthostatic hypotension, bradycardia, and syncope. However, less well-known is the potential withdrawal that can occur from its rapid discontinuation. Here, we describe a case of seizure-like activity that occurred 72 hours after an abrupt high-dose clozapine discontinuation in a patient with schizoaffective disorder, bipolar type. Seizures, although known to be a high-serum-concentration-dependent side effect of clozapine, could not be excluded as a possible withdrawal syndrome in this patient.
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