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  • Elevated clozapine levels associated with infection: A systematic review

    Author(s)
    Clark, Scott R
    Warren, Nicola S
    Kim, Gajin
    Jankowiak, David
    Schubert, Klaus Oliver
    Kisely, Steve
    Forrester, Tori
    Baune, Bernhard T
    Siskind, Dan J
    Griffith University Author(s)
    Kisely, Steve R.
    Year published
    2018
    Metadata
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    Abstract
    Clozapine is the most effective anti-psychotic medication for treatment refractory schizophrenia. A growing number of case reports have linked infection to high clozapine levels and associated adverse outcomes. We present a systematic review of published cases to clarify the relationship between infection and elevated clozapine levels. The case reports were located through PubMed and Embase. In addition, 8 new cases from two Australian states were included. Demographics, psychiatric diagnoses and medical morbidities, medications, clinical symptoms, clozapine levels, inflammatory markers and final clinical outcome were ...
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    Clozapine is the most effective anti-psychotic medication for treatment refractory schizophrenia. A growing number of case reports have linked infection to high clozapine levels and associated adverse outcomes. We present a systematic review of published cases to clarify the relationship between infection and elevated clozapine levels. The case reports were located through PubMed and Embase. In addition, 8 new cases from two Australian states were included. Demographics, psychiatric diagnoses and medical morbidities, medications, clinical symptoms, clozapine levels, inflammatory markers and final clinical outcome were extracted. 40 cases were identified in 23 publications that demonstrated elevated clozapine levels associated with infection. Infections were commonly respiratory in origin. Adverse events, typically sedation, were associated with raised clozapine levels during infection. In many cases the signs of infection such as fever and white blood cell count were reduced. Severe adverse effects were uncommon, with one case each of seizure, myocarditis and neutropenia. The relationship between infection, clozapine levels and adverse events is complex and multi-factorial. Monitoring of clozapine levels is essential during hospitalisation for infection and consideration should be given to gradual dose reduction to minimise dose related side effects.
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    Journal Title
    SCHIZOPHRENIA RESEARCH
    Volume
    192
    DOI
    https://doi.org/10.1016/j.schres.2017.03.045
    Subject
    Biomedical and clinical sciences
    Psychology
    Publication URI
    http://hdl.handle.net/10072/383626
    Collection
    • Journal articles

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