clozapine and Nausea

Following the conduct of a 28-day inpatient bioequivalence study of clozapine in schizophrenia patients, withdrawal effects after abrupt discontinuation from clozapine were assessed. Thirty patients who met DSM-III-R criteria for schizophrenia, residual type, or schizophrenia in remission were enrolled in the study. Patients were evaluated for symptoms of withdrawal effects for 7 days after clozapine 200 mg/day was abruptly withdrawn. Of 28 patients who completed the study, 11 had no withdrawal symptoms; 12 had mild withdrawal adverse events of agitation, headache, or nausea; four patients experienced moderate withdrawal adverse events of nausea, vomiting, or diarrhea; and one patient experienced a rapid-onset psychotic episode requiring hospitalization. Cholinergic rebound is a likely explanation for the mild to moderate withdrawal symptoms and is easily treated with an anticholinergic agent. Mesolimbic supersensitivity, as well as specific properties of clozapine, are discussed as likely causes for rapidonset psychosis. Our findings are consistent with previous reports of withdrawal reactions associated with clozapine, further reminding clinicians to monitor patients closely following abrupt discontinuation of clozapine.

Topics: Adolescent; Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Clozapine; Diarrhea; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Nausea; Neurologic Examination; Psychoses, Substance-Induced; Receptors, Cholinergic; Schizophrenia; Schizophrenic Psychology; Substance Withdrawal Syndrome; Vomiting

Clozapine is an atypical antipsychotic proven to be superior in the treatment of treatment-resistant schizophrenia. Myocarditis is a rare, but well-known complication of treatment with clozapine. Only few cases have been reported in which nausea and vomiting were prominent symptoms. This is the first described report in which nausea and vomiting were the only presenting symptoms of clozapine-induced myocarditis.. We report a case of a 58-year-old woman, suffering from schizoaffective disorder, who is being treated with clozapine. Two weeks after initiation of clozapine, she developed nausea and vomiting, in absence of any other clinical symptoms. Laboratory examination and magnetic resonance imaging confirmed the diagnosis of clozapine-induced myocarditis. Clozapine was discontinued and the patient recovered fully.. This case emphasizes the importance of recognizing myocarditis as a cause of isolated nausea and vomiting in patients treated with clozapine. Early recognition improves clinical outcome and reduces mortality.

Topics: Antipsychotic Agents; Clozapine; Female; Humans; Middle Aged; Myocarditis; Nausea; Vomiting

Topics: Adult; Antipsychotic Agents; Biopsy; Clozapine; Computed Tomography Angiography; Coronary Angiography; Diagnosis, Differential; Dyspnea; Electrocardiography; Fatigue; Follow-Up Studies; Humans; Magnetic Resonance Imaging, Cine; Male; Myocarditis; Myocardium; Nausea

Topics: Clozapine; Dopamine Antagonists; Dyskinesia, Drug-Induced; Female; Humans; Metoclopramide; Middle Aged; Nausea; Schizophrenia; Syndrome

Clozapine, as the model agent for the atypical antipsychotic drugs, is currently recommended as effective regarding negative symptoms of schizophrenia and treatment-resistant schizophrenic patients. This study focuses on the clozapine-induced side-effects in 100 hospitalized schizophrenic patients (negative and therapy-resistant forms), followed-up for a four year period. Clinically relevant side-effects occurred in 73% of all patients. Tachycardia (67%), the increase of liver enzymes (36%), hypotension (29%) and sedation (27%) were most frequent. Tachycardia, hypotension and sedation disappeared during the initial phase of treatment (i.e. 4-6 weeks), as tolerance developed with continuation of therapy. The increase of liver enzymes appeared to be dose related, since the reduction of daily clozapine dose led to the normalization of transaminases values. The other side-effects (constipation, nausea and vertigo) were rare and transient. Leucopenia was not registered in any patient during the follow-up period. Therefore, clozapine is efficient and, with some precautions concerning hepatotoxicity, is safe for in- and outpatient long-term treatment in appropriately selected patients.

Topics: Adult; Blood Pressure; Body Temperature; Clozapine; Constipation; Drug Resistance; Female; Follow-Up Studies; Humans; Liver; Male; Middle Aged; Nausea; Pulse; Salivation; Schizophrenia; Schizophrenic Psychology

Topics: Clozapine; Dibenzazepines; Dyskinesia, Drug-Induced; Humans; Metoclopramide; Nausea; Parkinson Disease, Secondary