Potential Risk of Clozapine Toxicity May Occur in Patients With COVID-19

Acase report inSchizophrenia Bulletin suggests that patients who are taking clozapine may be at risk of clozapine toxicity if they become infected with COVID-19. Clozapine is considered the best option for patients with treatment-resistant schizophrenia, but patients taking the medication are at heightened risk of a rare but serious condition known as neutropenia, which can increase risk of severe infections.In theSchizophrenia Bulletinreport, Thomas Cranshaw, M.B.B.S., and Thiyyancheri Harikumar, M.B.B.S., of Cumbria, Northumberland, Tyne, and Wear NHS Foundation Trust in England, described a 38-year-old man in an inpatient unit who was taking “325 mg per day of clozapine for organic psychosis” who became infected by COVID-19. The authors noted that after the initial emergence of COVID-19 symptoms (coughing, headache, and reduced oxygen saturation), the patient “was drowsy, with markedly increased hypersalivation and myoclonus.”A blood test revealed the patient ’s clozapine levels to be 0.73 mg/l, norclozapine 0.31 mg/l, which the authors noted was “substantially above the patient’s previous stable baseline of 0.57 mg/l, norclozapine 0.22 mg/l.” They added, “The most likely explanation is precipitation of clozapine toxicity by COVID-19 infection. Mechanisms for increase in plasma clozapine during infection have been shown to involve cytokine release downregulating the metabolism of clozapine in the P450 system through CYP 1A2.”The patient ’s clozapine w...
Source: Psychiatr News - Category: Psychiatry Tags: clozapine COVID-19 Schizophrenia Bulletin Thiyyancheri Harikumar Thomas Cranshaw toxicity Source Type: research