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dc.contributor.authorClark, Scott R
dc.contributor.authorWarren, Nicola S
dc.contributor.authorKim, Gajin
dc.contributor.authorJankowiak, David
dc.contributor.authorSchubert, Klaus Oliver
dc.contributor.authorKisely, Steve
dc.contributor.authorForrester, Tori
dc.contributor.authorBaune, Bernhard T
dc.contributor.authorSiskind, Dan J
dc.date.accessioned2019-07-05T12:32:00Z
dc.date.available2019-07-05T12:32:00Z
dc.date.issued2018
dc.identifier.issn0920-9964
dc.identifier.doi10.1016/j.schres.2017.03.045
dc.identifier.urihttp://hdl.handle.net/10072/383626
dc.description.abstractClozapine 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.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherElsevier Science
dc.relation.ispartofpagefrom50
dc.relation.ispartofpageto56
dc.relation.ispartofjournalSCHIZOPHRENIA RESEARCH
dc.relation.ispartofvolume192
dc.subject.fieldofresearchBiomedical and clinical sciences
dc.subject.fieldofresearchPsychology
dc.subject.fieldofresearchcode32
dc.subject.fieldofresearchcode52
dc.titleElevated clozapine levels associated with infection: A systematic review
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.hasfulltextNo Full Text
gro.griffith.authorKisely, Steve R.


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