clozapine and Serotonin-Syndrome

Topics: Clozapine; Drug Administration Schedule; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Risk Factors; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Serotonin Syndrome; Sertraline; Treatment Outcome

We describe a case of serotonin syndrome secondary to clozapine withdrawal and concomitant use of citalopram hydrobromide, a phenomenon that has been rarely reported.. This is a case report of a 47-year-old woman admitted to an academic medical center intensive care unit with coma, hypersalivation, hyperreflexia, and stimulus-induced clonus. The patient received a diagnosis of serotonin syndrome attributed to abrupt clozapine withdrawal with concomitant use of citalopram. She improved only minimally with supportive treatment (intravenous fluids, benzodiazapines, and withdrawal of selective serotonin-reuptake inhibitor) and received cyproheptadine hydrochloride on her third day of symptoms. Four hours after she received the loading dose of cyproheptadine, she was alert and oriented and at her baseline mental status, although some clonus remained.. Serotonin syndrome can result from the abrupt withdrawal of a 5-hydroxytryptamine receptor 2A antagonist from a treatment regimen that also includes a medication that increases serotonin availability.

Topics: Benzodiazepines; Citalopram; Clozapine; Cyproheptadine; Female; Humans; Middle Aged; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Serotonin Syndrome; Substance Withdrawal Syndrome

To report on the possible development of serotonin syndrome in a patient receiving clomipramine after clozapine was withdrawn from the treatment regimen.. A 44-year-old white man with a 23-year history of undifferentiated schizophrenia and obsessive-compulsive behavior had been treated with clozapine and clomipramine for several years. He tolerated both agents together well, with the exception of experiencing chronic constipation. Clomipramine was tapered and reduced to 50 mg over a period of 10 days. A worsening of ritualistic behavior was noted, and the clomipramine dosage was increased to 150 mg/d over 14 days. Simultaneously with the clomipramine dosage increase, clozapine was tapered and stopped ever a period of 19 days. The day after clozapine was stopped, while he was still receiving clomipramine 150 mg/d, he began behaving oddly, started sweating profusely, shivering, and became tremulous, agitated, and confused. He was diagnosed with possible serotonin syndrome; his symptoms resolved after clomipramine was stopped but before clozapine was restarted eight days later.. There are similarities in symptoms between serotonin syndrome and clozapine withdrawal. This article discusses the reasons why this case may represent serotonin syndrome rather than clozapine withdrawal and the possible pharmacologic mechanisms involved.. Clinicians should be aware that removing a serotonin-2a (S-HT2a) antagonist 1mm a treatment regimen including an agent that increases serotonin in the synaptic cleft may worsen clozapine withdrawal or potentially result in serious adverse drug reactions, such as serotonin syndrome.

Topics: Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Clomipramine; Clozapine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Serotonin Syndrome; Substance Withdrawal Syndrome

Topics: Animals; Clomipramine; Clozapine; Humans; Receptor, Serotonin, 5-HT2A; Receptors, Serotonin; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Serotonin Syndrome; Substance Withdrawal Syndrome

Topics: Antipsychotic Agents; Clozapine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fluoxetine; Humans; Male; Middle Aged; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Substance Withdrawal Syndrome