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Co-medication with disulfiram markedly increased serum clozapine levels: Two case reports
Lydia Hahl-Häkkinen1,2, Susanna Maria Rask1,2, Anssi Solismaa1,2
1Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Background:
Alcohol use disorder (AUD) is a significant co-morbidity in patients with schizophrenia. Clozapine offers some benefits in treating patients with refractory schizophrenia and AUD, but co-medicating with disulfiram is also common.
Procedures:
We report two cases where co-medicating with disulfiram led to a significant increase in clozapine serum levels.
Findings:
Clozapine serum levels decreased to one-third in Patient 1 when disulfiram was discontinued and started to increase again when disulfiram was reintroduced. Patient 2 developed toxic serum levels of clozapine during disulfiram treatment combined with heavy coffee drinking and symptoms reminiscent of neuroleptic malignant syndrome.
Conclusions:
Clozapine and disulfiram are both metabolized by cytochrome P450 CYP1A2 and clinically relevant interaction through this shared pathway is possible.
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