clozapine and Serositis

To identify the clinical determinants of fever in clozapine users and their impact on management of clozapine treatment.. Articles published in English or French identified with a MEDLINE, Web of Sciences, Cochrane Library and PsycINFO search, from inception through February 2019, using the term "clozapine" in combination with "fever" OR "hyperthermia" OR "body temperature" OR "pyrexia" OR "febrile" OR "heat" OR "thermoregulation". Information extracted for each medical condition were frequency, time to onset after initiation of clozapine treatment, characteristics of fever, associated symptoms, laboratory tests used for diagnosis, course, lethality, discontinuation of clozapine. Data were synthesized narratively.. Our search yielded 394 unique hits published from 1993 to 2018. We included 73 articles in the review: two meta-analyses, 14 reviews, six epidemiological studies, 11 clinical studies and 40 case reports. During clozapine initiation, fever is most frequently benign and transient but should be closely monitored as it may be the first stage of potentially life-threatening adverse drug reactions (ADR) (agranulocytosis, neuroleptic malignant syndrome myocarditis, hepatitis, pancreatitis, nephritis, colitis, etc.). Other ADR associated with fever are independent of duration of exposure to clozapine (heat stroke, pneumonia, pulmonary embolism, necrotizing colitis). If fever is due to intercurrent infection, therapeutic drug monitoring is recommended to adjust clozapine daily dosage.. Benign causes of fever are much more frequent than life-threatening ADR during clozapine treatment. Discontinuation should not be considered as automatic in the event of fever, especially during the early phase of clozapine initiation.

Topics: Agranulocytosis; Antipsychotic Agents; Chemical and Drug Induced Liver Injury; Clozapine; Colitis; Dose-Response Relationship, Drug; Drug Monitoring; Fever; Hepatitis; Humans; Infections; Lupus Erythematosus, Systemic; Myocarditis; Nephritis; Neuroleptic Malignant Syndrome; Pancreatitis; Pneumonia; Pulmonary Embolism; Schizophrenia; Serositis

Topics: Antipsychotic Agents; Clozapine; Female; Humans; Middle Aged; Psychotic Disorders; Serositis; Time Factors

Topics: Acute Disease; Adult; Antipsychotic Agents; Ascites; Chemical and Drug Induced Liver Injury; Clozapine; Female; Humans; Pleurisy; Psychotic Disorders; Serositis

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

A case report describes an adolescent girl with a treatment-resistant bipolar disorder, who developed pericarditis and polyserositis while being treated with clozapine. The sparse literature about this rare, severe side effect of clozapine is discussed. Clinical recommendations with regard to monitoring are given. If myocarditis/polyserositis occurs, clozapine has to be discontinued immediately.

Topics: Adolescent; Agranulocytosis; Antipsychotic Agents; Bipolar Disorder; Clozapine; Female; Humans; Pericarditis; Psychiatric Status Rating Scales; Serositis

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

Topics: Adult; Antipsychotic Agents; Clozapine; Female; Humans; Schizophrenia; Serositis; Sweet Syndrome

Clozapine was approved by the U.S. Food and Drug Administration in 1989 for treatment of severely ill schizophrenic patients. It has activity against both the positive and negative symptoms of schizophrenia, which has made it an alternative to traditional antipsychotic medications such as haloperidol. However, clozapine must be used cautiously due to its side effect profile. These side effects include agranulocytosis, seizures, and cardiorespiratory symptoms. We report the case of a patient who developed polyserositis (pericardial effusion, pleural effusion, and pericarditis) after being started on clozapine, and whose symptoms remitted upon discontinuation of clozapine. The literature is reviewed and the treatment implications are discussed.

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Schizophrenia; Serositis