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Case Reports
. 2024 Feb 8:17:111-120.
doi: 10.2147/IMCRJ.S444685. eCollection 2024.

Clozapine-Induced Severe Toxicity: Exploring the Pharmacokinetic Profile of Clozapine and Its Significance in Hemodynamic Instability - A Case Report

Zhu-Xi Yu  1 , Yang Pi  1 , Mei-Kai Chen  1 , Dan-Jiang Dong  1 , Qin Gu  1
Affiliations
Case Reports

Clozapine-Induced Severe Toxicity: Exploring the Pharmacokinetic Profile of Clozapine and Its Significance in Hemodynamic Instability - A Case Report

Zhu-Xi Yu et al. Int Med Case Rep J. .

Abstract

Hemodynamic instability in patients with clozapine intoxication can indirectly reflect the serum concentration of clozapine.We have described a case of a 32-year-old pregnant woman who developed life-threatening clozapine toxicity at 28 weeks of gestation. The levels of clozapine and norclozapine in the serum were high. We initiated hemoperfusion(HP) and other detoxification therapies to remove the drug. The patient had severely dilated peripheral blood vessels, which led to cardiac symptoms such as fatal hypotension and uncontrollable tachycardia, resulting in very high cardiac output and elevated Central venous oxygen saturation (ScvO2). Pharmacological intervention significantly improved the hemodynamics.In light of our observations in the ongoing case, we posit that evaluating hemodynamic parameters before and after blood detoxification could serve as a valuable means to gauge effectiveness and provide guidance for treatment.

Keywords: HP; PICCO; clozapine; hemoperfusion; pulse index continuous cardiac output; toxicity.

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Conflict of interest statement

The authors declare that they have no competing interests in this work.

Figures

Figure 1
Figure 1
Electrocardiography of the patient on admission.
Figure 2
Figure 2
Electrocardiography of the patient showing sinus tachycardia about 24 hours after taking clozapine.
Figure 3
Figure 3
The serum concentrations of clozapine and norclozapine during hospitalization.
Figure 4
Figure 4
The clozapine levels and the VDI index during hospitalization.
Figure 5
Figure 5
A positive correlation between VDI index and serum concentration of clozapine.
See this image and copyright information in PMC

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