clozapine and Pericardial-Effusion

We report the case of a multiple drug interaction involving clozapine, antifungals and oral contraceptives, which resulted in an increased clozapine plasma level, pericarditis with pericardial effusion and eosinophilia in a young Caucasian woman. These symptoms and signs disappeared a few days after discontinuation of clozapine. At present, we are not aware of reports of clozapine-antifungals interaction, whereas there is only one other case report on the interaction between oral contraceptives and clozapine. The purpose of this case report is to show the risk of potentially serious adverse effects stemming from drug interactions involving medications routinely used in clinical practice.. A 29-year-old Caucasian woman diagnosed with a schizoaffective disorder was admitted to a psychiatric unit for acute psychosis (hallucinations, delusions and catatonic behavior). She denied smoking tobacco products and was on long-term oral contraceptives. During the first month of hospitalization she was treated with antipsychotics and for 1 week she took simultaneously fluconazole and miconazole gel, after being diagnosed with oral candidiasis. On the last day of antifungals treatment, 29 days after admission, clozapine was started with resolution of psychotic symptoms. After 3 weeks, her clozapine plasma level had increased to 542 ng/mL and eosinophilia was observed. She complained of nausea, vomiting and palpitations; echocardiography showed echocardiographic abnormalities and pericardial effusion. Oral contraceptives were discontinued and after 1 week clozapine was interrupted, with a complete resolution of side effects and pericardial effusion within 4 days.. Clozapine is metabolized by cytochrome P450. The use of inhibitors or other substrates of cytochrome P450, such as antifungals and oral contraceptives, can cause long-lasting interactions and clozapine toxicity. The Naranjo algorithm shows clozapine is a definite cause of pericarditis (score 9) and both clozapine-antifungals and clozapine-contraceptives interactions resulted probable (score 5) in Drug Interaction Probability Scale. A good knowledge on drugs that act as substrates, inhibitors or inducers of cytochrome P450 is mandatory. When those drugs are used in patients taking clozapine, blood level monitoring of clozapine should be recommended, since a lower dose of clozapine might be required to prevent clozapine toxicity.

Topics: Adult; Antifungal Agents; Antipsychotic Agents; Clozapine; Contraceptives, Oral; Drug Interactions; Eosinophilia; Female; Humans; Pericardial Effusion; Pericarditis; Psychotic Disorders; Tachycardia, Sinus

To report a case of a patient treated with clozapine who developed pericarditis with pericardial effusion that resolved when the drug was discontinued.. Case report of a 21-year-old man with psychotic disorder that had been stable on clozapine therapy for five months (after failure of atypical antipsyhotic agents) presented to the emergency department complaining of chest pain and progressive shortness of breath that had lasted for a few days. Echocardiography showed a pericardial effusion suggestive of a cardiac tamponade, and the fluid was removed by pericardiocentesis. All other possible causes of the pericardial effusion were ruled out and clozapine was suspected as the most likely explanation. Clozapine was discontinued and the patient's symptoms improved markedly.. According to the Naranjo probability scale, clozapine is a probable cause of pericarditis. Although clozapine is a known cause of myocarditis and cardiomyopathy, there are only several reports in the literature describing clozapine-induced pericarditis and pericardial effusion. In our patient, the pericardial effusion cleared within several days following clozapine discontinuation.. There have been only a few cases of clozapine-induced pericarditis reported in the literature, however this adverse effect of clozapine can occur, as this case report clearly demonstrates. Cardiac adverse effects of clozapine are potentially life threatening, hence early recognition is essential to prevent serious outcomes.

Topics: Adult; Antipsychotic Agents; Clozapine; Echocardiography; Humans; Male; Pericardial Effusion; Pericarditis

This is the case of a young man suffering from schizophrenia and treated with clozapine. He developed acute heart failure associated with pericardial effusion and midventricular dyskinesia with severe systolic dysfunction and left ventricular dilatation at echocardiogram, readily resolved after the suspension of clozapine therapy. The segmental wall motion abnormalities observed at echocardiogram in this case are peculiar and have never been described before. The possible cardiotoxic effects of clozapine have been reported previously in the literature. Because of its serious potential side effects this drug is not considered the first choice for treatment of schizophrenia. Before beginning treatment, patients should undergo a cardiac evaluation, and they should also be periodically followed up with echocardiograms.

Topics: Acute Disease; Antipsychotic Agents; Clozapine; Heart Failure; Humans; Male; Myocardial Contraction; Myocarditis; Pericardial Effusion; Schizophrenia; Ultrasonography; Ventricular Dysfunction; Ventricular Function, Left; Ventricular Function, Right; Young Adult

Topics: Adolescent; Antipsychotic Agents; Clozapine; Cooperative Behavior; Humans; Interdisciplinary Communication; Male; Patient Care Team; Pericardial Effusion; Pericarditis; Referral and Consultation; Retreatment; Schizophrenia, Paranoid; Tachycardia, Sinus

Topics: Adult; Antipsychotic Agents; Clozapine; Echocardiography; Female; Humans; Pericardial Effusion; Schizophrenia

Clozapine is used in the treatment of resistant schizophrenia. It is used as a reserve drug mainly because of its adverse effect profile affecting gastrointestinal, haematological and cardiorespiratory systems. Cardiac side effects are uncommon but could be potentially life threatening, hence early recognition and active monitoring are essential to prevent serious cardiac side effects. A case of pericarditis with pericardial effusion is described in a patient who was recently started on clozapine which disappeared within 1 week after discontinuation of clozapine.

Topics: Adult; Antipsychotic Agents; Clozapine; Electrocardiography; Humans; Male; Pericardial Effusion; Pericarditis; Schizophrenia; Ultrasonography

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Cardiac Tamponade; Clozapine; Drug Eruptions; Drug Therapy, Combination; Female; Humans; Pericardial Effusion; Pericarditis; Pleural Effusion; Schizophrenia; Serositis; Valproic Acid

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Pericardial Effusion; Pleural Effusion; Schizophrenia, Paranoid

Topics: Adolescent; Antipsychotic Agents; Clozapine; Humans; Male; Pancreatitis; Pericardial Effusion; Schizophrenia, Paranoid

Topics: Acute Disease; Aged; Antipsychotic Agents; Clozapine; Humans; Male; Pericardial Effusion; Pleural Effusion; Psychotic Disorders; Serositis

Topics: Adult; Antipsychotic Agents; Clozapine; Follow-Up Studies; Humans; Male; Pericardial Effusion; Pericardiocentesis; Pericarditis; Schizophrenia, Paranoid; Treatment Outcome

Topics: Adult; Clozapine; Female; Humans; Pericardial Effusion; Pleural Effusion; Schizophrenia