Clozapine
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Liver injury: 2 case reports In a case series, a 33-year-old man and a 48-year-old woman were described, who developed liver injury during treatment with clozapine [routes not stated]* . Case 1: The man, who had schizophrenia, was initially treated with risperidone and paliperidone, and had been receiving olanzapine without good response. Therefore, clozapine 25 mg/day was added to the ongoing olanzapine. Clozapine dose was increased by 25mg every two days. On day 12 of clozapine therapy (when the clozapine dose was 150 mg/day), he developed diarrhoea, nausea and dizziness. In the next few days, his condition worsened with development of confusion and choluria. Laboratory investigation revealed elevated levels of ALT, ESR and serum bilirubin. He was therefore hospitalised, and was eventually diagnosed with clozapine-induced liver injury. Clozapine and olanzapine were thus interrupted. After 48 hours, full clinical recovery was noted. Leukocyte blood count and ESR were found to be still high in the first week. However, liver function test and bilirubin level progressively decreased. Within one month, all the laboratory investigations returned to normal. Two weeks later, olanzapine was re-initiated, without any changes in the liver function test results. Case 2: The woman, who had schizophrenia, had received risperidone and olanzapine to which a partial response was noted. Then, she started receiving clozapine 75 mg/day. Twenty days after initiation of clozapine, she developed nausea, vomiting, choluria, headache and abdominal pain. Laboratory investigations revealed elevated levels of ALT, AST, creatinine kinase, GGT and alkaline phosphatase. Investigations also revealed mild leucocytosis, haematuria, mild leucocyturia, and decreased Hb indicative of anaemia. She was diagnosed with clozapine-induced liver injury. Clozapine was therefore discontinued. She was re-initiated on olanzapine therapy. Within one month, her blood counts and liver function test results normalised. No hospitalisation was required. * Country of occurrence, reporter country and primary source country not stated. Unable to contact author. Part of the Abstracts of the 2020 Congress of the Schizophrenia International Research Society. Dias C, et al. Clozapine-induced hepatotoxicity: Two case reports. Schizophrenia Bulletin 46 (Suppl. 1): S212 (plus poster) abstr. M200, May 2020. Available from: URL: 803503236 https://www.ncbi.nlm.nih.gov/pmc/issues/357949/ [abstract]
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Reactions 26 Sep 2020 No. 1823
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