Influence of patient-related variables on clozapine plasma levels

Article Abstract:

Clozapine is a drug that is used to treat psychiatric disorders in both inpatients and outpatients. One benefit of using this drug is its lack of motor side effects, which are common with most other potent psychotropic drugs. However, a problem that has been associated with all psychotropic medications is the need to maintain a correct therapeutic blood plasma level of the drug. Monitoring of plasma levels is performed regularly to confirm patient compliance, minimize the dosage, and avoid over-medicating the patient. One hundred forty-eight psychiatric inpatients were given daily oral doses of clozapine. Drug concentrations were routinely monitored, along with other patient variables including age, sex, weight, and smoking habits. The drug was administered for a minimum of eight days, and doses ranged from 12.5 to 700 milligrams (mg) per day. Clozapine was given to the patients as needed, and blood tests were taken each morning at approximately 10 hours after treatment. All the variables examined (dose, age, sex, weight and smoking) had a significant influence on the patients' plasma clozapine concentrations. When the data were re-analyzed using only dosages between 150 and 500 mg/day, the influence of the variables remained statistically significant. Clear differences in plasma levels were observed by sex, and smokers had lower clozapine levels than nonsmokers taking the same doses. The study corroborates previous research and demonstrates the wide variability of drug concentrations which may be seen among patients. Because of the clinical significance of these findings, further studies are recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Dosage and administration, Psychotropic drugs

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Elevated clozapine plasma concentrations after fluvoxamine initiation

Article Abstract:

Plasma concentrations of clozapine increase during cotreatment with fluvoxamine. Three patients who were treated concurrently with clozapine and fluvoxamine showed elevated plasma clozapine levels during the comedication period. Conversely, withdrawal of the fluvoxamine regimen rapidly decreased clozapine plasma concentrations. These findings support previous observations that fluvoxamine could inhibit clozapine metabolism.

Research, Antidepressants, Drug interactions

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Diabetic ketoacidosis from clozapine and lithium cotreatment

Article Abstract:

Clozapine and lithium comedication resulted in diabetic ketoacidosis in a 46-year-old patient diagnosed with paranoid schizophrenia. Prior to the cotreatment regimen, the patient had no history of elevated serum glucose levels, polydipsia or other symptoms of diabetes or hyperglycemia. Following clozapine treatment, the patient was rushed to the hospital in a stupor and was found positive for diabetic ketoacidosis.

Complications and side effects, Lithium, Lithium (Metal), Diabetic acidosis, Diabetic ketoacidosis

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