Thirty years of both ignorance and clinical experience suggest that clozapine intoxication during co-occurring infections and inflammation may have higher morbidity and mortality than is currently believed

We1 previously described a massive increase in clozapine serum concentrations during pneumonia. Based on that case, prior published cases, and our clinical experience, we recommended that for clozapine patients with severe infections or inflammations, the clinician order clozapine therapeutic drug monitoring (TDM) and, when TDM is not possible, consider cutting the clozapine dose in half. Leung2 provided an intelligent commentary on our case. We only disagree with two of his statements: 1) a dose reduction by half may not be appropriate for all patients with infection, especially in the absence of adverse drug reactions (ADRs), and 2) free clozapine concentrations should be measured.
Source: Psychosomatics - Category: Psychiatry & Psychology Authors: Tags: Letter to the Editor Source Type: research