Delirium on clozapine: A tale of friend turned foe-A case report

2020 ◽  
pp. 009121742097282 ◽  
Author(s):  
Aparna Das ◽  
Rebecca Minner ◽  
Lewis Krain ◽  
John Spollen
Keyword(s):  
Case Report ◽  
Clinical Practice ◽  
Side Effects ◽  
Adverse Effects ◽  
Older Adult ◽  
Psychiatric Illness ◽  
Management Strategies ◽  
Treatment Resistant ◽  
Drug Of Choice ◽  
Life Threatening

Treatment resistant schizophrenia (TRS) is often encountered in clinical practice. Clozapine remains the drug of choice in the management of TRS. Several studies have shown that clozapine is the most effective antipsychotic medication to date for TRS. But it is also well known that it has multiple side effects. Some side effects are transient and relatively benign, while other adverse effects are menacing, serious and life-threatening. Delirium may occur with clozapine and is a therapeutic challenge as there is always a risk of precipitating delirium on clozapine rechallenge. Limited management strategies are available as alternatives for the management of psychiatric illness stabilized on clozapine. In this case report, we describe an older adult patient who developed delirium on clozapine. The aims of this case report are to discuss the mechanism by which clozapine leads to delirium, revisit various factors which could possibly lead to delirium, and discuss the different management strategies available for management of psychiatric illness for a patient previously stabilized on clozapine.

scholarly journals Rapid-onset supraventricular tachycardia following clozapine initiation and its management with verapamil: a case report

2019 ◽  
Vol 6 (2) ◽  
pp. 547
Author(s):  
Afnan A. Alwabili
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Adverse Effects ◽  
Supraventricular Tachycardia ◽  
Low Dose ◽  
Rapid Onset ◽  
Treatment Resistant ◽  
Early Stages ◽  
Drug Of Choice ◽  
Cardiovascular Side Effects

Clozapine is the drug of choice for treatment-resistant schizophrenia. However, the use of clozapine is limited by its serious adverse effects, which often underlie its discontinuation. The cardiovascular side effects that raise safety concerns include tachycardia, myocarditis and cardiomyopathy. The development of clozapine-induced tachycardia is usually observed on higher dosage especially at early stages of treatment. Here, author presented the case of a patient with treatment-resistant schizophrenia who developed asymptotic supraventricular tachycardia despite low dose of clozapine at the second day of treatment. Additionally, author explored the possibility of clozapine re-challenge in combination with verapamil treatment.

Clozapine induced myocarditis: a case report and literature review

2009 ◽  
Vol 26 (3) ◽  
pp. 147-148 ◽  
Author(s):  
Sunday O Okereke ◽  
Wan MY Mohd Abdoh ◽  
Bernadette M Murphy
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Literature Review ◽  
Fatal Case ◽  
Treatment Resistant ◽  
Cardiac Side Effects ◽  
Drug Of Choice ◽  
High Level

AbstractClozapine, the drug of choice for treatment resistant schizophrenia, has a range of serious cardiac side-effects. This paper describes a fatal case of myocarditis in a 48 year old man four weeks after starting clozapine. In particular, this case illustrates how incipient the disorder can be and the need for a high level of suspicion. Difficulties in diagnosing clozapine induced myocarditis and ways to minimise its risk are also discussed.

scholarly journals Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

2018 ◽  
Vol 9 (5) ◽  
pp. 237-256 ◽  
Author(s):  
Domenico De Berardis ◽  
Gabriella Rapini ◽  
Luigi Olivieri ◽  
Domenico Di Nicola ◽  
Carmine Tomasetti ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Treatment Adherence ◽  
Line Treatment ◽  
Treatment Resistant ◽  
Everyday Clinical Practice ◽  
Drug Of Choice ◽  
Psychiatric Hospitalizations ◽  
Wide Range ◽  
Poor Treatment ◽  
Life Threatening

Clozapine, a dibenzodiazepine developed in 1961, is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. Since its introduction, it has remained the drug of choice in treatment-resistant schizophrenia, despite a wide range of adverse effects, as it is a very effective drug in everyday clinical practice. However, clozapine is not considered as a top-of-the-line treatment because it may often be difficult for some patients to tolerate as some adverse effects can be particularly bothersome (i.e. sedation, weight gain, sialorrhea etc.) and it has some other potentially dangerous and life-threatening side effects (i.e. myocarditis, seizures, agranulocytosis or granulocytopenia, gastrointestinal hypomotility etc.). As poor treatment adherence in patients with resistant schizophrenia may increase the risk of a psychotic relapse, which may further lead to impaired social and cognitive functioning, psychiatric hospitalizations and increased treatment costs, clozapine adverse effects are a common reason for discontinuing this medication. Therefore, every effort should be made to monitor and minimize these adverse effects in order to improve their early detection and management. The aim of this paper is to briefly summarize and provide an update on major clozapine adverse effects, especially focusing on those that are severe and potentially life threatening, even if most of the latter are relatively uncommon.

Elucidating the Potential Side Effects of Current Anti- Seizure Drugs for Epilepsy

2021 ◽  
Vol 19 ◽  
Author(s):  
Enes Akyüz ◽  
Mohd. Farooq Shaikh ◽  
Betül Köklü ◽  
Cansu Ozenen ◽  
Alina Arulsamy
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adverse Effects ◽  
Side Effect ◽  
First Line ◽  
Epileptic Patients ◽  
Life Threatening ◽  
Visual Problems ◽  
Gaba Transmission

: Over the decades, various interventions have been developed and utilized to treat epilepsy. However, majority of epileptic patients are often first prescribed with anti-epileptic drugs (AED), now known as anti-seizure drugs (ASD), as a first line of defense to suppress their seizures and regain their quality of life. ASDs exert their anti-convulsant effects through various mechanisms of action including regulation of ion channels, blocking of glutamate-mediated stimulating neurotransmitter interaction, and enhancing the inhibitory GABA transmission. About one third of epileptic patients are often resistant to anti-convulsant drugs, while others develop numerous side effects which may lead to treatment discontinuation and further deterioration of quality of life. Common side effects of ASDs include headache, nausea and dizziness. However, more adverse effects such as auditory and visual problems, skin problems, liver dysfunction, pancreatitis and kidney disorders may also be witnessed. Some ASDs may even result in life-threatening conditions as well as serious abnormalities, especially in patients with comorbidities and in pregnant women. Nevertheless, some clinicians had observed a reduction in the development of side effects post individualized ASD treatment. This suggest that a careful and well-informed ASD recommendation to patients may be crucial for an effective and side-effect free control of their seizures. Therefore, this review aimed to elucidate the anticonvulsant effects of ASDs as well as their side effect profile, by discussing their mechanism of action and reported adverse effects based on clinical and preclinical studies, thereby providing clinicians with a greater understanding of the safety of current ASDs.

Clozapine Induced Rash: Case Report of Successful Desensitization

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Singh ◽  
K. Raju ◽  
J. Southern ◽  
J. Darroch
Keyword(s):  
Side Effects ◽  
Drug Hypersensitivity ◽  
Effective Means ◽  
Drug Dose ◽  
Delayed Type Hypersensitivity ◽  
Psychotic Symptoms ◽  
Hypersensitivity Reactions ◽  
Treatment Resistant ◽  
Drug Of Choice ◽  
Cutaneous Hypersensitivity

Aim:Clozapine is the drug of choice for patients with treatment-resistant schizophrenia. However a minority of them have been unable to continue with Clozapine due to side-effects, for example rash. This report looks at the use of graded desensitization in a patient who developed cutaneous reactions to Clozapine.Method:This report describes the management of a patient with treatment resistant-schizophrenia, mild learning disabilities and epilepsy, following a cutaneous reaction to Clozapine. Having been maintained on Clopixol depot until 4 years ago, he required a change in antipsychotics following a relapse of psychotic symptoms. He was then treated unsuccessfully with various anti-psychotics, before starting Clozapine, to which he showed a good response. Unfortunately he developed an eczematous rash on two separate occasions when the drug was introduced. Again he was tried on other anti-psychotics, to which he also developed a rash. He was then put on a graded desensitization regimen of liquid Clozapine.Results:Graded desensitization, using incremental increases in drug dose, allowed maintenance treatment with therapeutic doses of Clozapine to be achieved in the absence of cutaneous hypersensitivity reactions. the patient's previously treatment-resistant psychotic symptoms were improved by this method.Conclusion:We should be aware of possibilities for the management of both the common and uncommon side-effects associated with Clozapine, as the result might vastly improve the patients’ quality of life. Desensitisation regimens can be an effective means of overcoming drug hypersensitivity but should be used with great caution, especially when patients exhibit delayed-type hypersensitivity reactions.

Nanomedicine

2015 ◽  
pp. 64-89
Author(s):  
Roy Gaurab ◽  
Shetti Dattatrya ◽  
Yadav Amit ◽  
Kundu Gopal C
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Therapeutic Effect ◽  
21St Century ◽  
Delivery Systems ◽  
Imaging Agents ◽  
Life Threatening

Nanomedicine, an offshoot of nanotechnology, is considered as one of the most promising technologies of the 21st century. Due to their minute size, nanomedicines can easily target difficult-to-reach sites with improved solubility and bioavailability and reduced adverse effects. They also act as versatile delivery systems, carrying both chemotherapeutics and imaging agents to targeted sites. Hence, nanomedicine can be used to achieve the same therapeutic effect at smaller doses than their conventional counterparts and can offer impressive resolutions for various life-threatening diseases. Although certain issues have been raised about the potential toxicities of nanomaterials, it is anticipated that the advances in nanomedicine will furnish clarifications to many of modern medicine's unsolved problems. This chapter aims to provide a comprehensive and contemporary survey of various nanomedicine products along with the major risks and side effects associated with the nanoparticles.

Defining the role of glucocorticoids in inflammation

2018 ◽  
Vol 132 (14) ◽  
pp. 1529-1543 ◽  
Author(s):  
Simona Ronchetti ◽  
Graziella Migliorati ◽  
Stefano Bruscoli ◽  
Carlo Riccardi
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Adverse Effects ◽  
Molecular Mechanisms ◽  
Molecular Targets ◽  
Great Promise ◽  
Body Of Knowledge ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

An established body of knowledge and clinical practice has argued in favor of the use of glucocorticoids in various chronic inflammatory and autoimmune diseases. However, the very well-known adverse effects associated with their treatment hampers continuation of therapy with glucocorticoids. Analyses of the molecular mechanisms underlying the actions of glucocorticoids have led to the discovery of several mediators that add complexity and diversity to the puzzling world of these hormones and anti-inflammatory drugs. Such mediators hold great promise as alternative pharmacologic tools to be used as anti-inflammatory drugs with the same properties as glucocorticoids, but avoiding their metabolic side effects. This review summarizes findings about the molecular targets and mediators of glucocorticoid function.

Fatal hyperkalemia following succinylcholine administration in a child on oral propranolol

2015 ◽  
Vol 30 (1) ◽  
Author(s):  
Anuradha Ganigara ◽  
Chandrakala Ravishankar ◽  
Chandrika Ramavakoda ◽  
Madhavi Nishtala
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Side Effects ◽  
Drug Combination ◽  
Neuromuscular Block ◽  
Severe Effect ◽  
Adrenergic Blocker ◽  
Life Threatening ◽  
Adrenergic Blockers ◽  
Oral Propranolol

AbstractSuccinylcholine is one of the most commonly used drugs by anesthesiologists worldwide for rapid access to airway both in emergency and elective situations. Nonetheless, the very mention of succinylcholine generates the most energetic high decibel debate between its users and nonusers. Despite its potential to produce a short-acting, ultra-intense neuromuscular block rapidly in seconds, it is surrounded by a plethora of side effects and drug interactions. This case report is about one such drug interaction of this innocent yet malicious drug, which resulted in the death of a 14-year-old girl. Both β-adrenergic blockers and succinylcholine are known to cause hyperkalemia. Life-threatening hyperkalemia in susceptible individuals who have been administered succinylcholine has the most severe effect on the myocardium and can result in asystole with minimal chances of resuscitation. Both succinylcholine and a nonselective β-adrenergic blocker, propranolol, have the propensity to affect the transcellular redistribution of potassium which can result in hyperkalemia. We advocate cautious use of this drug combination till further studies confirm the drug interaction and find the potential triggering factors involved.

scholarly journals Canadian Expert Panel Recommendations on the Management of CNS Symptoms Related to Efavirenz

2001 ◽  
Vol 12 (suppl c) ◽  
pp. 20C-30C ◽  
Author(s):  
M John Gill ◽  
Anita Rachlis ◽  
Sharon Walmsley ◽  
Mark Halman ◽  
The Efavirenz Consensus Working Group
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Health Care Providers ◽  
Highly Active Antiretroviral Therapy ◽  
Primary Care Physicians ◽  
Sleep Disturbances ◽  
Present Report ◽  
Management Strategies ◽  
Routine Practice ◽  
Care Providers

Efavirenz is a potent antiretroviral agent used in combination with other antiretroviral agents as part of highly active antiretroviral therapy. Efavirenz is generally well tolerated because the majority of its adverse effects are self-limiting, with central nervous symptoms and rash being the most frequent. In routine practice, the discontinuation rate of efavirenz due to adverse effects appears higher than that described in clinical trials. To minimize early treatment interruption and maximize the benefit of long term viral suppression that can be achieved with efavirenz therapy, health care providers and patients have identified that there is a need for information, education about and practical tools for the management of efavirenz-related side effects. To this end, a panel of experts in the care of HIV patients consisting of primary care physicians, infectious disease specialists, psychiatrists and pharmacists was convened. Through the evaluation of current literature and discussion among the group, the panel arrived at consensus recommendations. The present report outlines general management recommendations that apply to adverse effects related to efavirenz initiation, as well as specific management strategies for central nervous system symptoms such as agitation, sleep disturbances, dreams, dizziness, impaired concentration and depression. It is hoped that these practical recommendations will aid clinicians in minimizing and improving patient tolerance of side effects, thereby achieving improved adherence and patient outcomes.

Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review

1996 ◽  
Vol 41 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Gb Meterissian
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Features ◽  
Prior History ◽  
Extrapyramidal Side Effects ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
The One

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. Methods: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. Results: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. Conclusions: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.

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