Skelly Megan K, Demler Tammie Lee, Lee Claudia
Drs. Skelly, Demler, and Lee are with the State University at Buffalo (SUNY) School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice in Buffalo, New York.
Drs. Demler and Lee are also with New York State Office of Mental Health, Buffalo Psychiatric Center in Buffalo, New York.
Innov Clin Neurosci. 2019 Jul 1;16(7-08):22-24. eCollection 2019 Jul-Aug.
Clozapine, a second-generation antipsychotic (SGA), is known for its superior efficacy in the treatment of refractory schizophrenia. Clozapine's hallmark side effects are well-known, including, but not limited to, drug-induced seizures associated with daily goal doses greater than 600mg and rapid dose escalation, which can also contribute to significant risk of orthostatic hypotension, bradycardia, and syncope. However, less well-known is the potential withdrawal that can occur from its rapid discontinuation. Here, we describe a case of seizure-like activity that occurred 72 hours after an abrupt high-dose clozapine discontinuation in a patient with schizoaffective disorder, bipolar type. Seizures, although known to be a high-serum-concentration-dependent side effect of clozapine, could not be excluded as a possible withdrawal syndrome in this patient.
氯氮平是一种第二代抗精神病药物（SGA），以其在治疗难治性精神分裂症方面的卓越疗效而闻名。氯氮平的标志性副作用广为人知，包括但不限于与每日目标剂量大于600mg及快速剂量递增相关的药物性癫痫发作，这也可能导致显著的直立性低血压、心动过缓和晕厥风险。然而，其快速停药可能引发的戒断反应却鲜为人知。在此，我们描述一例双相型分裂情感障碍患者在大剂量氯氮平突然停药72小时后出现癫痫样活动的病例。癫痫发作虽然已知是氯氮平高血清浓度依赖性副作用，但在该患者中不能排除其为可能的戒断综合征。
