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Cross-titration from risperidone to clozapine utilizing clozapine serum concentrations: A case report
Nicolette Centanni1, Kayla Garvey1, Elizabeth Mullany1
1Maine Medical Center, Portland, Maine, USA.
Pharmacotherapy
|January 21, 2025
Summary
This case study shows that using serum clozapine levels can help guide the transition from risperidone to clozapine in schizophrenia patients, especially with drug interactions.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Second-generation antipsychotics clozapine and risperidone treat schizophrenia.
- Lack of guidelines for antipsychotic cross-titration and limited data on using serum drug levels.
- Patient presented with schizophrenia, Parkinson's disease, and was on risperidone and fluoxetine.
Observation:
- A 68-year-old female patient was admitted after a fall.
- The patient underwent cross-titration from risperidone to clozapine over 17 days.
- Serum clozapine levels guided the dose adjustments during this transition.
Findings:
- Successful transition from risperidone to clozapine was achieved.
- Serum clozapine levels and clinical status were used to guide the cross-titration.
- The process occurred despite multiple potential drug-drug interactions.
Implications:
- Serum drug levels may be beneficial for guiding antipsychotic cross-titration.
- This approach is particularly useful in complex cases with drug interactions.
- Clinical status alongside serum levels is crucial for safe medication management.
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