Clozapine
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Delirium: case report A 44-year-old man developed delirium following reinitiation of clozapine after a short interruption in treatment. The man, who had schizophrenia, had been receiving clozapine 500 mg/day for 7 months. He did not collect his medication for 2 days. The following morning, he was given his usual clozapine 500mg dose. Within a few hours, he had impaired consciousness and became autistic, disoriented and fidgety. The man was taken to an emergency department. It was concluded that his delirium was caused by clozapine intoxication. He disappeared for 6 days, then refused to take his medication because of Ramadan. Three days later, he agreed to voluntary admission. A clozapine build-up schedule was developed. However, because of an oversight, he received clozapine 500mg 10 days after his previous intake. Once again, he developed comparable symptoms of delirium within a few hours. He was admitted to a psychiatric hospital and, that evening, his delirium cleared again. He became well oriented, and more lucid and efficient. The following evening, he received olanzapine. The dose was doubled after three and ten days. He was suspected to have delirium again. His symptoms fluctuated; he was calm and clear by day, but was agitated and more paranoid during the night. He seemed disoriented and had decreased attention. Olanzapine was suspended and he had no further symptoms of delirium. Author comment: This case shows that a causal relationship between the rapid build-up of clozapine following a short discontinuation of treatment and the occurrence of delirium as a result of the rechallenge is very plausible. Benckhuijsen JAW, et al. Delirium on re-starting clozapine after a short break in treatment. Tijdschrift voor Psychiatrie 49: 661-665, No. 9, 2007 [Dutch; 801079164 summarised from a translation] - Netherlands
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Reactions 13 Oct 2007 No. 1173
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