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Case Reports
. 2023 Feb;37(2):229-233.
doi: 10.1177/02698811221148611. Epub 2023 Jan 26.

Co-medication with disulfiram markedly increased serum clozapine levels: Two case reports

Lydia Hahl-Häkkinen  1   2 , Susanna Maria Rask  1   2 , Anssi Solismaa  1   2 , Sanna Ruuhonen  1   2 , Esa Leinonen  1   2
Affiliations
Case Reports

Co-medication with disulfiram markedly increased serum clozapine levels: Two case reports

Lydia Hahl-Häkkinen et al. J Psychopharmacol. 2023 Feb.

Abstract

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.

Keywords: Alcohol use disorder; clozapine; disulfiram; interaction; toxicity.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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