Veerman S R T, Bogers J P A M, Cohen D, Schulte P F J
Tijdschr Psychiatr. 2021;63(7):499-508.
The Clozapine Plus Working Group is frequently consulted for advice on measures in case of infection with SARSCoV-2 and on vaccination against COVID-19 in patients receiving clozapine.
AIM: Inform about risks of infection with SARS-CoV-2 in patients with severe mental illness (SMI), patients with schizophrenia spectrum disorders (SSD), and patients treated with clozapine. Advise on monitoring of clozapine plasma levels and white blood cell count and differential in COVID-19 and after vaccination, as well as measures to be taken.
METHOD: Literature research and case studies.
RESULTS: SMI patients and in particular SSD patients have an increased risk of infection with SARS-CoV-2 with more hospitalizations and higher mortality than non-psychiatric patients. Patients using clozapine may be at greater risk of infection. SARS-CoV-2 infection may cause a dangerous increase of clozapine plasma levels and generally mild and short-term granulocytopenia and lymphocytopenia, which are usually not a result of clozapine treatment.
CONCLUSION: In case of COVID-19 extra alertness is required in patients with SMI and especially SSD. In clozapine users, in case of COVID-19, reduction in dose by half to three quarters of the original dose is recommended. When patients develop granulocytopenia, SARS-CoV-2 should be considered as the cause and not immediately clozapine. SMI patients and clozapine users in particular belong to a high risk group with a medical indication for early vaccination.
氯氮平联合工作组经常就感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）时的应对措施以及接受氯氮平治疗的患者接种新型冠状病毒肺炎（COVID-19）疫苗的相关问题提供咨询建议。
目的：告知严重精神疾病（SMI）患者、精神分裂症谱系障碍（SSD）患者以及接受氯氮平治疗的患者感染SARS-CoV-2的风险。就COVID-19期间及接种疫苗后氯氮平血药浓度、白细胞计数及分类的监测以及应采取的措施提供建议。
方法：文献研究和病例分析。
结果：SMI患者，尤其是SSD患者感染SARS-CoV-2的风险增加，住院率和死亡率均高于非精神科患者。使用氯氮平的患者感染风险可能更高。SARS-CoV-2感染可能导致氯氮平血药浓度危险升高，通常还会引起轻度短期粒细胞减少和淋巴细胞减少，这通常不是氯氮平治疗的结果。
结论：对于SMI患者，尤其是SSD患者，在发生COVID-19时需要格外警惕。对于使用氯氮平的患者，如发生COVID-19，建议将剂量减半至原剂量的四分之三。当患者出现粒细胞减少时，应考虑SARS-CoV-2为病因，而非立即认为是氯氮平所致。SMI患者，尤其是氯氮平使用者属于高风险人群，有早期接种疫苗的医学指征。
