Westmead Hospital Intensive Care Unit, Sydney, Australia.
University New South Wales, Sydney, Australia.
BMC Psychiatry. 2021 Apr 13;21(1):192. doi: 10.1186/s12888-021-03199-x.
Caffeine is a known inhibitor of Clozapine metabolism mediated by inhibition of CYP1A2. Hitherto, the effects of caffeine on Clozapine levels have always been modest, as have the clinical manifestations of toxicity resulting from their interaction. We present a case of severe toxicity associated with the co-consumption of caffeine and Clozapine culminating in life-threatening complications requiring management in Intensive Care.
A 34 year old male with a history of chronic schizophrenia, who had been managed stably on 400 mg Clozapine for the previous 5 years, changed his dietary behaviour and began consuming caffeine-containing energy drinks over the course of 3 weeks. The total daily dose of caffeine was estimated as 600 mg/day (four cans of Red Bull). He subsequently presented to the Emergency Department with life-threatening Clozapine toxicity, resulting in a decreased level of consciousness, severe metabolic acidosis, acute respiratory failure, raised inflammatory markers and acute renal failure attributed to interstitial nephritis. Maximum recorded Clozapine level was 1796 ng/ml.
This case describes the interaction between a common caffeine-containing beverage and a commonly prescribed antipsychotic medication, associated with severe adverse effects. We call for clinical and scientific attention to the possible interaction between these substances and draw attention to the implications for prescribing practices and patient counselling.
咖啡因是一种已知的 CYP1A2 介导的氯氮平代谢抑制剂。迄今为止，咖啡因对氯氮平水平的影响一直是适度的，因为它们相互作用导致的毒性的临床表现也是如此。我们报告了一例与咖啡因和氯氮平同时摄入相关的严重毒性病例，最终导致危及生命的并发症，需要在重症监护室进行治疗。
一名 34 岁男性，有慢性精神分裂症病史，在过去 5 年中一直稳定服用 400mg 氯氮平，改变了饮食习惯，开始在 3 周内饮用含咖啡因的能量饮料。咖啡因的日总剂量估计为 600mg/天（四罐红牛）。随后，他因危及生命的氯氮平毒性而到急诊科就诊，导致意识水平下降、严重代谢性酸中毒、急性呼吸衰竭、炎症标志物升高和急性肾损伤归因于间质性肾炎。记录到的最高氯氮平水平为 1796ng/ml。
本病例描述了一种常见含咖啡因饮料与一种常用抗精神病药物之间的相互作用，与严重不良事件有关。我们呼吁临床和科学界关注这些物质之间可能存在的相互作用，并提请注意对处方实践和患者咨询的影响。
