合用双硫仑显著增加氯氮平的血清水平：两例报告。
Co-medication with disulfiram markedly increased serum clozapine levels: Two case reports.
机构信息
Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Psychiatry, Tampere University Hospital, Tampere, Finland.
出版信息
J Psychopharmacol. 2023 Feb;37(2):229-233. doi: 10.1177/02698811221148611. Epub 2023 Jan 26.
BACKGROUND
Alcohol use disorder (AUD) is a significant co-morbidity in patients with schizophrenia. Clozapine offers some benefits in treating patients with refractory schizophrenia and AUD, but co-medicating with disulfiram is also common.
PROCEDURES
We report two cases where co-medicating with disulfiram led to a significant increase in clozapine serum levels.
FINDINGS
Clozapine serum levels decreased to one-third in Patient 1 when disulfiram was discontinued and started to increase again when disulfiram was reintroduced. Patient 2 developed toxic serum levels of clozapine during disulfiram treatment combined with heavy coffee drinking and symptoms reminiscent of neuroleptic malignant syndrome.
CONCLUSIONS
Clozapine and disulfiram are both metabolized by cytochrome P450 CYP1A2 and clinically relevant interaction through this shared pathway is possible.
背景
酒精使用障碍（AUD）是精神分裂症患者的一种严重共病。氯氮平在治疗难治性精神分裂症和 AUD 患者方面具有一定优势，但也常与双硫仑联合用药。
方法
我们报告了两例因联合使用双硫仑导致氯氮平血药浓度显著升高的病例。
结果
停用双硫仑后，患者 1 的氯氮平血药浓度降至三分之一，再次使用双硫仑时又开始升高。患者 2 在双硫仑治疗期间合并大量饮用咖啡，并出现类神经阻滞剂恶性综合征的症状，导致氯氮平血药浓度中毒。
结论
氯氮平和双硫仑均通过细胞色素 P450 CYP1A2 代谢，通过这种共同途径可能存在临床相关的相互作用。
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