Clozapine/pramipexole interaction
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Psychosis: case report A 56-year-old woman developed psychosis following concomitant administration of clozapine and pramipexole. The woman was admitted with acute paranoia, religious and somatic preoccupation and erratic behaviour. Her medical history was significant for schizophrenia, which was well controlled on clozapine for the past 30 years. Upon review of medicinal history, it was noticed that 3 months prior to the occurrence of these psychiatric symptoms, she had started receiving pramipexole 0.5mg daily [route not stated] for restless leg syndrome (RLS) [aetiology of RLS not stated]. On hospital day 5, she started receiving valproic acid to target impulsivity, distractibility and disorganised thought processes. Three days later, valproic acid level was found to be within the reference range. Additionally, the dose of clozapine was up-titrated to 350mg; despite that, she continued to show the psychiatric symptoms. Initial laboratory tests (blood cell count, serum electrolytes, liver and renal function, thyroid-stimulating hormone, urinalysis, ammonia, urine drug screen, inflammatory markers, syphilis and HIV antibody and magnesium levels) were found to be unremarkable. A head CT-scan and ECG were also unremarkable. A diagnosis of psychosis was therefore suspected. At the time of admission, the levels of clozapine and norclozapine were found to be within the therapeutic range (392 µg/L and 216 µg/L, respectively). It was thus suspected that a drug interaction might have occurred between clozapine and pramipexole, which might have contributed to the psychosis. The woman’s therapy with pramipexole was therefore discontinued, and fluphenazine was added to the ongoing clozapine and valproic acid to target her residual psychotic symptoms. No further signs of psychosis was observed while receiving clozapine, valproic acid and fluphenazine. She was discharged after 17 days of hospitalisation. Amador EC, et al. Schizophrenia With Decompensation on Clozapine With Pramipexole. Primary Care Companion for CNS Disorders 21: No. 6, 26 Dec 2019. Available 803500783 from: URL: http://doi.org/10.4088/PCC.19l02436
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Reactions 12 Sep 2020 No. 1821
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