de Leon Jose, Ruan Can-Jun, Verdoux Hélène, Wang Chuanyue
University of Kentucky Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky, USA.
Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing, China.
Gen Psychiatr. 2020 Apr 16;33(2):e100183. doi: 10.1136/gpsych-2019-100183. eCollection 2020.
Clinicians need to remember that (1) systemic inflammations can increase clozapine level; (2) clozapine, by itself, can cause inflammation, particularly during titration that is too rapid for that patient; (3) clozapine may increase the risk of infection; and (4) more specifically, clozapine may be particularly strongly associated with the risk of pneumonia. Pneumonia appears to be associated with high mortality in clozapine patients around the world. Clinicians who are alert to the risk of pneumonia in clozapine patients may significantly decrease mortality in clozapine patients. There is no data on COVID-19 infections in clozapine patients, but based on what we know about clozapine pharmacology, we can hypothesise that clozapine, possibly by impairing immunological mechanisms, may increase the risk of pneumonia in infected patients. More importantly, once fever and/or pneumonia develops, the clozapine dose should be cut in half to decrease the risk of clozapine intoxication. If there is any doubt that in spite of halving the dose there are still signs of clozapine intoxication, completely stopping clozapine may be indicated. Once the signs of inflammation and fever have disappeared, the clozapine dose can be increased to the prior dosage level.
（1）全身性炎症会使氯氮平水平升高；（2）氯氮平本身可引发炎症，尤其是在滴定速度对该患者而言过快时；（3）氯氮平可能会增加感染风险；（4）更具体地说，氯氮平可能与肺炎风险特别密切相关。在全球范围内，肺炎似乎与氯氮平治疗的患者的高死亡率相关。对氯氮平治疗患者的肺炎风险保持警惕的临床医生可能会显著降低氯氮平治疗患者的死亡率。目前尚无关于氯氮平治疗患者感染新冠病毒的数据，但基于我们对氯氮平药理学的了解，我们可以推测，氯氮平可能通过损害免疫机制，增加感染患者患肺炎的风险。更重要的是，一旦出现发热和/或肺炎，应将氯氮平剂量减半，以降低氯氮平中毒的风险。如果尽管剂量减半仍有氯氮平中毒迹象，可能需要完全停用氯氮平。一旦炎症和发热迹象消失，可将氯氮平剂量增加至先前的剂量水平。
