| Original language | English |
|---|---|
| Pages (from-to) | 652-656 |
| Number of pages | 5 |
| Journal | Psychosomatics |
| Volume | 58 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 2017 |
Bibliographical note
Funding Information:This male Chinese smoker displayed a major elevation in clozapine levels (>2000 ng/mL) during the peak of pneumonia, with the median clozapine C/D ratio increasing from 1.3–6.9. Clozapine may be associated with greater risk of pneumonia than other antipsychotics. Clinicians need to be aware that pneumonia and other severe infections/inflammations can be associated with potential for major elevations in clozapine serum concentrations and potential for clozapine intoxication. It is important to collect a trough clozapine TDM and consider adjusting the clozapine dosage whenever a clozapine patient develops (1) a severe infection or inflammation or (2) a CRP elevation which suggests an undiagnosed infection/inflammation. 17 In this patient, the highest peak TDM was not available on the same day it was ordered, but it indicated that the clozapine dose should be cut by 4/5, which is much higher than in other published cases. ng/mL was known, this would have substantially reduced the risks. In summary, in an ideal world, clinicians should receive clozapine TDM results on the same day that TDM levels were collected in the early morning and use that to personalize dosing in that specific patient. If that is not possible, they could start by cutting the dose in half until TDM data arrives. Finally, all clinicians using clozapine need to warn their patients and families to contact them when severe infections, such as pneumonia, develop and make them aware of the potential for clozapine intoxication. 5,7 Based on the limited literature and our personal experience, 7 we are conservative and in favor of a simple recommendation, as was made for theophylline many years ago 3 ; if clozapine TDM is not available or it takes several days for results to arrive, clinicians should consider cutting the clozapine dosage in half during the infection/inflammation. If this patient׳s psychiatrist had used that recommendation of cutting the dose in half as soon as the highest level of 2032.7 Acknowledgments: The authors are grateful to the reviewer who helped them to improve the text and table of this article. The authors acknowledge Lorraine Maw, M.A., at the Mental Health Research Center at Eastern State Hospital, Lexington, KY, who helped in editing this article. Disclosure: No commercial organizations had any role in writing this paper for publication. All authors declare no competing interest during the last 36 months. All authors meet criteria for authorship and approved the final manuscript. The study was financed by 3 grants to the Beijing Anding Hospital. The principal investigators were Dr. Ruan ( Beijing Science and Technology Plan Project Z171100001017074 ), Dr. Guo ( Beijing Science and Technology Plan Project Z151100004015180 ), and Dr. Wang ( Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding ZY201403 ). Appendix A
Funding Information:
Disclosure: No commercial organizations had any role in writing this paper for publication. All authors declare no competing interest during the last 36 months. All authors meet criteria for authorship and approved the final manuscript. The study was financed by 3 grants to the Beijing Anding Hospital. The principal investigators were Dr. Ruan (Beijing Science and Technology Plan Project Z171100001017074), Dr. Guo (Beijing Science and Technology Plan Project Z151100004015180), and Dr. Wang (Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding ZY201403).
ASJC Scopus subject areas
- Arts and Humanities (miscellaneous)
- Applied Psychology
- Psychiatry and Mental health
