Clozapine treatment during the COVID-19 pandemic
Introduction Clozapine is an effective antipsychotic used in treatment-resistant schizophrenia. One of the serious complications of clozapine therapy is agranulocytosis, therefore regular monitoring of the level of white blood cells (WBC) in plasma is necessary. During acute inflammatory infection...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-04-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933821017776/type/journal_article |
| _version_ | 1797616388458676224 |
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| author | E. Dąbrowska B. Galińska-Skok D. Zalewski A. Nobis |
| author_facet | E. Dąbrowska B. Galińska-Skok D. Zalewski A. Nobis |
| author_sort | E. Dąbrowska |
| collection | DOAJ |
| description |
Introduction
Clozapine is an effective antipsychotic used in treatment-resistant schizophrenia. One of the serious complications of clozapine therapy is agranulocytosis, therefore regular monitoring of the level of white blood cells (WBC) in plasma is necessary. During acute inflammatory infections, including the COVID-19 infection, levels of clozapine may increase, by the CYP 450 system, leading to adverse effects such as sedation, hypersalivation and consequently to aspiration pneumonia.
Objectives
The aim of the study is to assess the validity of continuing clozapine treatment during the COVID-19 pandemic.
Methods
Brief literature review, based on research of scientific articles published in PubMed, using as keywords the terms “clozapine” and “COVID-19”.
Results
Research studies indicate that SARS-COV2 infection in patients treated with clozapine does not significantly reduce the level of neutrophils, despite commonly observed leucopenia with lymphopenia. Due to pandemic, existing WBC scheme has been modified with a trend towards less frequent measurements. To minimize the side effects of clozapine during infection, it is recommended to reduce the dose of clozapine by half and continue lower dose until 3 days after fever has subsided. Additionally, there have been reports of psychosis recurrence after discontinuation of clozapine causing difficulties in treatment COVID-19 as also comorbid mental disease.
Conclusions
Treatment of clozapine is associated with higher risk of COVID-19 complications and at the same time COVID-19 infection may increase clozapine toxicity. Therefore, the risks of COVID-19 infection present a challenge for safe clozapine use. Further research will be needed to assess these dependencies and strategies.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:40:13Z |
| format | Article |
| id | doaj.art-937afa1ef8d24bccbffaaf32a2c54ec5 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:40:13Z |
| publishDate | 2021-04-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-937afa1ef8d24bccbffaaf32a2c54ec52023-11-17T05:08:49ZengCambridge University PressEuropean Psychiatry0924-93381778-35852021-04-0164S669S67010.1192/j.eurpsy.2021.1777Clozapine treatment during the COVID-19 pandemicE. Dąbrowska0B. Galińska-Skok1D. Zalewski2A. Nobis3Department Of Psychiatry, Medical University of Bialystok, Choroszcz, PolandDepartment Of Psychiatry, Medical University of Bialystok, Choroszcz, PolandDepartment Of Psychiatry, Medical University of Bialystok, Choroszcz, PolandDepartment Of Psychiatry, Medical University of Bialystok, Choroszcz, Poland Introduction Clozapine is an effective antipsychotic used in treatment-resistant schizophrenia. One of the serious complications of clozapine therapy is agranulocytosis, therefore regular monitoring of the level of white blood cells (WBC) in plasma is necessary. During acute inflammatory infections, including the COVID-19 infection, levels of clozapine may increase, by the CYP 450 system, leading to adverse effects such as sedation, hypersalivation and consequently to aspiration pneumonia. Objectives The aim of the study is to assess the validity of continuing clozapine treatment during the COVID-19 pandemic. Methods Brief literature review, based on research of scientific articles published in PubMed, using as keywords the terms “clozapine” and “COVID-19”. Results Research studies indicate that SARS-COV2 infection in patients treated with clozapine does not significantly reduce the level of neutrophils, despite commonly observed leucopenia with lymphopenia. Due to pandemic, existing WBC scheme has been modified with a trend towards less frequent measurements. To minimize the side effects of clozapine during infection, it is recommended to reduce the dose of clozapine by half and continue lower dose until 3 days after fever has subsided. Additionally, there have been reports of psychosis recurrence after discontinuation of clozapine causing difficulties in treatment COVID-19 as also comorbid mental disease. Conclusions Treatment of clozapine is associated with higher risk of COVID-19 complications and at the same time COVID-19 infection may increase clozapine toxicity. Therefore, the risks of COVID-19 infection present a challenge for safe clozapine use. Further research will be needed to assess these dependencies and strategies. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933821017776/type/journal_articleCOVID-19treatment-resistent schizophreniaclozapinecoronavirus |
| spellingShingle | E. Dąbrowska B. Galińska-Skok D. Zalewski A. Nobis Clozapine treatment during the COVID-19 pandemic European Psychiatry COVID-19 treatment-resistent schizophrenia clozapine coronavirus |
| title | Clozapine treatment during the COVID-19 pandemic |
| title_full | Clozapine treatment during the COVID-19 pandemic |
| title_fullStr | Clozapine treatment during the COVID-19 pandemic |
| title_full_unstemmed | Clozapine treatment during the COVID-19 pandemic |
| title_short | Clozapine treatment during the COVID-19 pandemic |
| title_sort | clozapine treatment during the covid 19 pandemic |
| topic | COVID-19 treatment-resistent schizophrenia clozapine coronavirus |
| url | https://www.cambridge.org/core/product/identifier/S0924933821017776/type/journal_article |
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