The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report

Clozapine, an atypical antipsychotic, has proved to be superior to other antipsychotics in treating patients with refractory schizophrenia. An increased plasma clozapine level above the therapeutic window may be associated with serious adverse events including paralytic ileus. Clozapine toxicity may...

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Main Authors: Khalid Abou Farha, Andre van Vliet, Henderikus Knegtering, Richard Bruggeman
Format: Article
Language:English
Published: Wiley 2012-01-01
Series:Case Reports in Psychiatry
Online Access:http://dx.doi.org/10.1155/2012/592784
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author Khalid Abou Farha
Andre van Vliet
Henderikus Knegtering
Richard Bruggeman
author_facet Khalid Abou Farha
Andre van Vliet
Henderikus Knegtering
Richard Bruggeman
author_sort Khalid Abou Farha
collection DOAJ
description Clozapine, an atypical antipsychotic, has proved to be superior to other antipsychotics in treating patients with refractory schizophrenia. An increased plasma clozapine level above the therapeutic window may be associated with serious adverse events including paralytic ileus. Clozapine toxicity may occur in association with infection or after drug overdose. In a medical emergency situation, differentiating between a toxic clozapine ingestion and an infection-induced toxicity might be hindered by associated CNS changes and by the clozapine modulation of the inflammatory process. This may delay prompt initiation of a tailored treatment strategy. Here, we report a case of paralytic ileus developed within the context of clozapine toxicity. Although the underlying cause of toxicity was not clinically obvious, giving antimicrobial therapy resulted in an improvement in the patient’s clinical condition. This report indicates the value of serum levels of C-reactive protein and desmethylclozapine, major metabolite of clozapine, in the treatment of aetiologically unclear clozapine toxicity.
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spelling doaj-art-74ee80c070024b7480ec827f8ddb10032025-02-03T01:11:28ZengWileyCase Reports in Psychiatry2090-682X2090-68382012-01-01201210.1155/2012/592784592784The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case ReportKhalid Abou Farha0Andre van Vliet1Henderikus Knegtering2Richard Bruggeman3QPS Netherlands B.V. 9713 GZ Groningen, The NetherlandsPRA International, 9471 GP Zuidlaren, The NetherlandsLentis Mental Health Organisation, 9725 AG Groningen, The NetherlandsRob Giel Onderzoekscentrum, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The NetherlandsClozapine, an atypical antipsychotic, has proved to be superior to other antipsychotics in treating patients with refractory schizophrenia. An increased plasma clozapine level above the therapeutic window may be associated with serious adverse events including paralytic ileus. Clozapine toxicity may occur in association with infection or after drug overdose. In a medical emergency situation, differentiating between a toxic clozapine ingestion and an infection-induced toxicity might be hindered by associated CNS changes and by the clozapine modulation of the inflammatory process. This may delay prompt initiation of a tailored treatment strategy. Here, we report a case of paralytic ileus developed within the context of clozapine toxicity. Although the underlying cause of toxicity was not clinically obvious, giving antimicrobial therapy resulted in an improvement in the patient’s clinical condition. This report indicates the value of serum levels of C-reactive protein and desmethylclozapine, major metabolite of clozapine, in the treatment of aetiologically unclear clozapine toxicity.http://dx.doi.org/10.1155/2012/592784
spellingShingle Khalid Abou Farha
Andre van Vliet
Henderikus Knegtering
Richard Bruggeman
The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
Case Reports in Psychiatry
title The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
title_full The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
title_fullStr The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
title_full_unstemmed The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
title_short The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
title_sort value of desmethylclozapine and serum crp in clozapine toxicity a case report
url http://dx.doi.org/10.1155/2012/592784
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