clozapine and Urinary-Tract-Infections

We describe a 58-year-old Chinese man with schizophrenia who presented with an elevated clozapine level suspected to be related to acute infection.

Topics: Antipsychotic Agents; Clozapine; Drug Resistance; Humans; Male; Middle Aged; Schizophrenia; Urinary Tract Infections

Topics: Antipsychotic Agents; Clozapine; Female; Humans; Middle Aged; Psychotic Disorders; Urinary Tract Infections

Topics: Antipsychotic Agents; Clozapine; Female; Humans; Middle Aged; Myoclonus; Schizophrenia; Urinary Tract Infections

Topics: Abdominal Pain; Adult; Antipsychotic Agents; Clozapine; Combined Modality Therapy; Diagnostic Errors; Dibenzothiazepines; Drug Therapy, Combination; Female; Fever; Fluid Therapy; Headache; Hemodiafiltration; Humans; Lithium; Multiple Organ Failure; Norepinephrine; Quetiapine Fumarate; Schizophrenia; Systemic Inflammatory Response Syndrome; Urinary Tract Infections; Valproic Acid; Vasoconstrictor Agents

Three case vignettes are presented documenting the rise in serum clozapine that occurred at a time of acute infection in these patients. The literature on this phenomenon is scant. The physiological processes that occur in the acute phase of the inflammatory response are summarized and provide an explanation of how clozapine levels may rise in response to infection. The risk of clozapine toxicity occurring in association with infections is highlighted.

Topics: Adult; Antipsychotic Agents; C-Reactive Protein; Clozapine; Drug Therapy, Combination; Escherichia coli Infections; Female; Humans; Leukocyte Count; Male; Middle Aged; Pneumonia, Bacterial; Psychoses, Substance-Induced; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Urinary Tract Infections

Topics: Acute Disease; Antipsychotic Agents; Bipolar Disorder; Clozapine; Female; Humans; Middle Aged; Urinary Tract Infections

A 20-year-old woman had for the preceding 11 weeks been receiving clozapine (225 mg/d) for an endogenous psychosis when she developed a urinary tract infection with fever. The blood count showed 2100 white cells/microliter without any neutrophils, the count having been normal 5 days previously. Physical examination was normal except for a fever of 39 degrees C and parodontitis. The red cell count was 3.9 mill/microliters, platelet count 443,000/microliters. Bone marrow biopsy revealed almost complete stop of proliferation and maturation in granulocytopoiesis so that granulocyte colony-stimulating factor (300 micrograms daily subcutaneously) had to be administered in addition to supportive measures. The granulocyte count at first fell to 1400 cells/microliter, but nine days after starting the drug myeloblasts, promyelocytes and myelocytes reappeared in peripheral blood for the first time. On the tenth day, administration of the growth factor was discontinued. An overshoot granulocytopoiesis occurred in bone marrow on the 13th day; on the 22nd day after treatment had been started the patient had a normal blood picture and was discharged.

Topics: Adult; Agranulocytosis; Blood Cell Count; Bone Marrow; Clozapine; Female; Granulocyte Colony-Stimulating Factor; Humans; Psychotic Disorders; Urinary Tract Infections