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Diltiazem for clozapine-induced generalized hyperhidrosis
Emma M Kenton1, Samantha M Zoellner2, Leigh Anne Nelson1,2
1PharmD, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri.
The Mental Health Clinician
|October 20, 2023
Summary
Calcium channel blockers effectively treat clozapine-induced hyperhidrosis, offering a safer alternative when anticholinergic medications are not tolerated. This approach improves patient management for antipsychotic side effects.
Area of Science:
- Pharmacology
- Clinical Psychiatry
Background:
- Clozapine, an atypical antipsychotic, is associated with various side effects.
- Hyperhidrosis is an uncommon but challenging side effect of clozapine treatment.
- The anticholinergic properties of clozapine often lead clinicians to overlook hyperhidrosis as a potential adverse effect.
Observation:
- A 34-year-old female patient experienced nocturnal, generalized hyperhidrosis after titration to 400 mg/day of clozapine.
- Reducing the clozapine dose did not alleviate the hyperhidrosis.
- Anticholinergic treatment was contraindicated due to constipation, and beta-blockers exacerbated asthma.
Findings:
- Diltiazem CD, a calcium channel blocker, administered at 180 mg/day significantly reduced clozapine-induced hyperhidrosis.
- This case demonstrates the efficacy of calcium channel blockers in managing this specific side effect.
Implications:
- Calcium channel blockers represent a viable therapeutic option for clozapine-induced hyperhidrosis.
- This strategy provides an alternative to anticholinergic agents, potentially improving clozapine tolerability.
- Effective management of hyperhidrosis can enhance patient adherence to clozapine therapy.
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