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Elevated clozapine levels in patients with COVID-19 infection

Published online by Cambridge University Press:  13 August 2021

J. Marti Bonany*
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
E. Pérez Sánchez
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
M. Pérez Carre
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
M.I. Martínez Casamitjana
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
J.R. Fortuny Olive
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
C. Macias Castellví
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
E. Carrió Diez
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
F. Lana Moliner
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
R. Sánchez González
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
*
*Corresponding author.

Abstract

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Introduction

Clozapine is the most effective antipsychotic for treatment resistant schizophrenia. In patients treated with clozapine, COVID-19 infection may result in complications including an increased risk of pneumonia, clozapine toxicity, and disruption to clozapine treatment by COVID-19 induced lymphopenia.

Objectives

We report 5 cases of elevated clozapine levels occurring in patients with COVID-19 infection who had been previously managed for several years on stable doses.

Methods

Subjects: 48 admitted patients to a long-stay psychiatric unit. COVID-19 infection confirmed by positive nasopharyngeal swab for viral ribonucleic acid of SARS-CoV-2. Hematological controls between March and April 2020.

Results

16 patients (33%) treated with clozapine.18 patients (37’5%) had COVID-19 infection, of which 5 (10’4%) were treated with clozapine. Results are presented in table 1. Increases in plasma clozapine levels were observed in all cases (49’38 to 307.5%). We don’t have the clozapine levels of a patient who presented a pneumonia requiring admission and treatment in the general hospital. Two cases of neutropenia were observed, of which one had to discontinue treatment with clozapine. In the other three patients the dose of clozapine was reduced and they did not present haematological or intoxication complications that required further adjustments.

Conclusions

Covid-19 infection is associated with increased serum clozapine levels by probably multifactorial mechanisms (systemic infection, reduced smoking). Importance of full clinical assessment of suspected COVID-19 infection in clozapine treated patients, including assessment clozapine level, and full blood count. The general recommendation is to reduce the dose of clozapine in this patients.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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