Pui-yin Chung Joseph, Shiu-yin Chong Catherine, Chung Ka-fai, Lai-wah Dunn Eva, Wai-nang Tang Orlando, Chan Wah-fat
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
Can J Psychiatry. 2008 Dec;53(12):857-62. doi: 10.1177/070674370805301211.
To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit.
A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever.
Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8 degrees C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02).
Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.
确定当地精神科病房中使用氯氮平患者样本中氯氮平所致发热的发生率、特征及预测因素。
对2003年3月至2006年12月开始使用氯氮平的227例新住院患者的病历进行回顾性研究。记录并分析人口统计学特征、发热情况、所做检查、发热特征及发热并发症。将氯氮平所致发热患者与未发热患者在人口统计学和临床因素方面进行比较。进行多因素逻辑回归分析以确定氯氮平所致发热的预测因素。
227例患者中有31例（13.7%）出现氯氮平所致发热。氯氮平开始使用后氯氮平所致发热的平均起病天数及发热持续时间分别为13.7天和4.7天。最高体温平均值为38.8摄氏度。79%的氯氮平所致发热患者在停用氯氮平后48小时内体温恢复正常。7例患者中有1例（14.3%）再次使用氯氮平时发热。氯氮平所致发热与滴定速度超过50mg/周（比值比18.9；95%可信区间5.3至66.7；P<0.01）、同时使用丙戊酸盐（比值比3.6；95%可信区间1.5至8.9；P = 0.01）及存在躯体疾病（比值比3.2；95%可信区间1.2至8.3；P = 0.02）有关。
氯氮平所致发热较为常见。暂时停用氯氮平可能使发热消退，发热消退后可考虑再次使用氯氮平。对于有基础躯体疾病及同时接受丙戊酸盐治疗的患者，较慢的氯氮平滴定速度可能有益。
