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A 40-year-old man with schizophrenia showed lack of efficacy with various antipsychotic medications, including aripiprazole, clozapine, fluoxetine, mirtazapine, olanzapine, and risperidone. Despite receiving treatment for 13 years, his negative symptoms persisted, leading to functional impairment. After undergoing 20 sessions of intermittent theta burst stimulation, he began to show improvement in his symptoms. [Extracted from the article]

A case report from South Korea described a female patient who developed neutropenia while being treated with clozapine for psychosis. The patient was also found to have COVID-19 during her hospitalization. Neutropenia was diagnosed as a side effect of clozapine, leading to discontinuation of the medication and subsequent resolution of the condition. After reinitiating clozapine therapy, there was no recurrence of neutropenia. [Extracted from the article]

A case report in the journal "Reactions Weekly" describes a 58-year-old man with paranoid schizophrenia who developed neutropenia while being treated with clozapine. The man also showed lack of efficacy with quetiapine, leading to his admission to a psychiatric unit. Various medications were tried with varying degrees of success, including aripiprazole, lurasidone, and sodium-valproate. Despite some improvements with clozapine rechallenge and electroconvulsive therapy, the man struggled with stress and disturbances, ultimately leading to an extended stay in a psychiatric hospital. [Extracted from the article]

A 71-year-old woman experienced various toxicities, including nausea, vomiting, impaired consciousness, and rapid heart rate, after intentionally overdosing on clozapine tablets. Her initial blood clozapine concentration was significantly above the therapeutic range, leading to complications such as hypotension and muscle tremors. Through intensive care, including haemoperfusion and monitoring, her blood clozapine levels eventually decreased to a therapeutic range, and her mental state improved after 14 days of treatment. [Extracted from the article]

A retrospective chart review of 120 patients from 2018 to 2020 described six cases of patients, aged 26-60, who developed various toxicities such as neutropenia, weight gain, constipation, and dyslipidaemia while being treated with clozapine or sodium valproate for treatment-resistant schizophrenia or seasonal affective disorder. The patients experienced these adverse effects within different time frames of initiating the medications, leading to the discontinuation of clozapine in most cases. Laboratory tests indicated the resolution of neutropenia after discontinuation of clozapine in some patients. [Extracted from the article]

A man in his 40s developed hepatitis while being treated with clozapine for schizophrenia and experienced lack of efficacy with olanzapine. Despite initial treatment with olanzapine, his symptoms worsened, leading to a switch to clozapine. However, after 37 days on clozapine, he developed hepatitis, which was attributed to the medication. Treatment with ursodeoxycholic acid improved his liver function, allowing for successful rechallenge with clozapine, ultimately leading to improvement in his psychiatric symptoms. [Extracted from the article]

A 47-year-old woman with schizophrenia developed constipation, dysarthria, lightheadedness, and abdominal symptoms due to increased plasma drug concentration from a drug-drug interaction between clozapine and suvorexant. She had been hospitalized for catatonic symptoms and was initially treated with clozapine along with other medications. After discontinuing suvorexant and reducing the clozapine dose, her symptoms improved and her clozapine plasma levels returned to normal. [Extracted from the article]

A 14-year-old girl with early onset schizophrenia exhibited lack of efficacy while being treated with olanzapine. After experiencing a recurrence of psychotic symptoms following discharge, she required a second hospitalization due to homicidal and suicidal risk. Subsequent treatment with clozapine and aripiprazole led to improvement, and she was eventually discharged and continued to be monitored in an outpatient clinic. [Extracted from the article]

A 54-year-old man with treatment-resistant schizophrenia developed myocarditis while on clozapine and Pisa syndrome while on haloperidol-decanoate. Initially treated with clozapine and olanzapine, he later switched to haloperidol-decanoate due to clozapine-induced myocarditis. After an increase in haloperidol-decanoate dosage, he developed Pisa syndrome, which was treated with an anticholinergic medication, resolving the symptoms. [Extracted from the article]

A 48-year-old man with a history of schizophrenia exhibited drug ineffectiveness during treatment with clozapine and amisulpride for resistant schizophrenia. Despite being treated with clozapine and amisulpride, the medications were not effective in addressing persecutory delirium and fratricide ideas. The man was eventually diagnosed with ultraresistant schizophrenia and underwent electroconvulsive therapy (ECT) and continued treatment with clozapine. After experiencing a fever following his fourth ECT session, various examinations were conducted, and his fever resolved within two hours. [Extracted from the article]

Two case reports were described in a study of 38,349 patients conducted between 1993 and 2016. The patients, who were diagnosed with schizophrenia, developed agranulocytosis while being treated with a combination of clozapine, mirtazapine, and quetiapine. One patient died as a result of agranulocytosis caused by clozapine and mirtazapine, while the other patient died due to agranulocytosis caused by clozapine and quetiapine. The dosages, routes, and duration of the treatments leading to these reactions were not stated. [Extracted from the article]

A 40-year-old man with schizophrenia and intellectual disability developed anaemia while being treated with clozapine. He was admitted to the hospital after experiencing asthenia and a low haemoglobin count. Blood tests revealed normocytic, normochromic, and non-regenerative anaemia, as well as elevated leukocytes and platelets. The man's anaemia resolved after discontinuing clozapine treatment, and his blood cell levels returned to normal. [Extracted from the article]

Researchers from Saudi Arabia have reported that medication errors related to clozapine are common, with a total of 1165 errors reported to the Ministry of Health between January 2018 and September 2022. The majority of these errors involved adults, with most being male, and were primarily detected by pharmacy staff. The most common types of errors included missing prescription information, incorrect doses, and medication name errors. Fortunately, the majority of errors did not reach patients, and very few resulted in patient harm. The researchers suggest that their findings could help inform efforts to reduce medication errors and improve patient safety related to clozapine use in the country. [Extracted from the article]

In a retrospective study of 958 patients with psychotic disorders treated with clozapine, five patients experienced a recurrence of seizures. These patients had a history of seizures and were receiving daily doses of clozapine ranging from 325-600 mg. The dosages of clozapine were reduced for all patients, except for one who maintained the same dosage. The study does not provide information on the routes of administration, duration of treatment, or specific outcomes for these patients. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventIn a retrospective study involving 42 patients, two elderly patients [sexes and exact ages not stated] were described, who developed agranulotosis (1 patient) and aspiration pneumonia (1 patient) secondary to clozapine while being treated for mental disorder [routes, dosages, duration of treatments to reactions onset not stated]. Eventually, clozapine was discontinued in both the patients [ADR outcomes not stated]. [Extracted from the article]

A case report published in Reactions Weekly describes a 42-year-old man with schizophrenia who developed sinus tachycardia while being treated with clozapine. The patient's symptoms gradually responded to the medication, but he experienced persistent tachycardia. As a result, he was prescribed ivabradine for the tachycardia, but after 5 days of treatment, he developed delirium. The ivabradine was discontinued, and the delirium symptoms improved. The patient continued to be treated with clozapine and showed improvement in his schizophrenia. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventIn a single center, retrospective cohort study of 44 patients,enrolled between July 2011 and October 2020, an adult patient [age not clearly stated and sex not stated] was described, who developed pericardial effusion during treatment with clozapine, and underwent pericardiocentesis [route, dosage, and indication not stated; duration of treatment to reaction onset and outcome not stated]. [Extracted from the article]

A patient with schizophrenia experienced lack of efficacy while being treated with amisulpride, aripiprazole, clozapine, sertraline, and trazodone. They also developed rhabdomyolysis while taking cariprazine. Despite trying different medications, the patient did not see improvement in their symptoms. Electroconvulsive therapy was eventually used, which initially led to improvement but later the symptoms returned. The patient's medication was adjusted, but there was still no improvement. Rhabdomyolysis was attributed to cariprazine and the medication was stopped, resulting in remission of the symptoms. [Extracted from the article]

A case series published in Reactions Weekly describes a 38-year-old man with chronic schizophrenia who did not respond to treatment with clozapine. Despite receiving clozapine, the patient continued to experience persistent primary negative symptoms. However, when the patient was given pramipexole, his motivation, expressiveness, and social engagement improved. After two weeks, his negative symptom scores decreased by 50% and his clozapine dose was subsequently reduced. [Extracted from the article]

A study published in JAMA Psychiatry found that certain antipsychotic medications, including clozapine, quetiapine, and olanzapine, increase the risk of pneumonia in patients with schizophrenia. The study analyzed data from Finnish registers between 1972 and 2014 and included 61,889 patients with schizophrenia. While overall antipsychotic use did not significantly increase the risk of pneumonia, antipsychotic monotherapy did, and the risk was dose-dependent. Specifically, high-dose clozapine, medium-dose clozapine, high-dose quetiapine, and high-dose olanzapine were associated with an increased risk of pneumonia. The authors suggest implementing prevention strategies for patients taking these antipsychotics to reduce the incidence of pneumonia. [Extracted from the article]

In a retrospective study conducted in South Africa, two adult patients were identified who developed ileus or neutropenia while receiving treatment with clozapine or cotrimoxazole. In the first case, a patient developed ileus as a result of clozapine therapy, but the condition was successfully managed without surgery. In the second case, an HIV-positive patient experienced a decrease in neutrophil count after starting clozapine and cotrimoxazole, leading to the discontinuation of both medications. After discontinuation, the patient's neutrophil count returned to normal. [Extracted from the article]

A 30-year-old man with schizophrenia developed neuroleptic-malignant-syndrome, serotonin-syndrome, and mydriasis after discontinuing clozapine while being treated with clozapine, haloperidol, and metoclopramide. Norepinephrine also contributed to the development of mydriasis. The man presented to the emergency department with fever, vomiting, and diarrhea, and was later diagnosed with acalculous cholecystitis and septic shock. He received treatment and gradually improved, with clozapine being reintroduced during his hospitalization. [Extracted from the article]

A 35-year-old man experienced a seizure and neuroleptic malignant syndrome (NMS) after misusing and not adhering to his prescribed medication for resistant schizophrenia. He had initially shown improvement with chlorpromazine and haloperidol, but stopped taking them. He then started taking clozapine, but discontinued it for six months due to a shortage and later took it without medical advice. He developed NMS and a seizure as a result. After discontinuing clozapine and starting olanzapine, his condition did not improve. However, when clozapine was reintroduced at a higher dose, his overall condition improved and there was no recurrence of NMS. [Extracted from the article]

A 34-year-old man with bipolar disorder and intellectual disability experienced gastrointestinal hypomotility and lack of efficacy while taking clozapine, quetiapine, and benzatropine. He was admitted to the hospital with worsening bipolar symptoms and received senna-alexandrina for constipation. After starting clozapine, he developed severe gastrointestinal symptoms and was admitted to the ICU with septic shock. Treatment with antibiotics, bowel rest, and other interventions led to his recovery. The authors concluded that the interaction between the three medications caused the gastrointestinal issues. [Extracted from the article]

A 38-year-old woman with refractory schizophrenia developed agranulocytosis while being treated with clozapine. After 10 years of clozapine treatment, her blood count showed neutropenia and agranulocytosis progression. Clozapine was stopped and she was treated with olanzapine, which restored her haematological values. However, she experienced psychotic decompensation and her treatment was restarted with clozapine in combination with olanzapine, resulting in a complete response. During the rechallenge, a decline in absolute neutrophil count was observed but remained within the normal range. [Extracted from the article]

A 48-year-old man with schizophrenia experienced sedation, thinking impairment, sialorrhoea (excessive saliva production), and walking disability while being treated with clozapine and quetiapine. The man had a history of hospitalizations for psychotic episodes but had been asymptomatic since 2013 while on the medication regimen. He denied substance abuse and reported reducing his tobacco use. The symptoms were determined to be a result of the clozapine and quetiapine, and the man's dosage was gradually reduced, leading to the disappearance of the symptoms. He was subsequently discharged. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventIn retrospective study of 50 patients, et al. patient [age and sex not stated] was described, who developed QTc prolongation during antipsychotic therapy with clozapine [route, dosage, duration of treatment to reaction onset and outcome not stated]. The patient received antipsychotic therapy with clozapine. However, the patient was found to developed new QTc prolongation related to clozapine. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventA patient [age and sex not stated] developed pericardial effusion during treatment with clozapine for schizoaffective disorder [route, dosage and duration of treatment to reaction onset not stated].The patient started receiving clozapine for treatment resistant schizoaffective disorder. However, the patient developed pericardial effusion. Later, the treatment with clozapine was stopped [ADR outcome not stated]. [Extracted from the article]

A 46-year-old man developed diarrhea while being treated with clozapine for schizoaffective disorder. He experienced two episodes of severe diarrhea with fever and was admitted to the hospital. Initially, the symptoms were thought to be related to Crohn's disease, but the digestive team later determined that the diarrhea was associated with clozapine. The man's clozapine treatment was stopped, but the outcome of the adverse drug reaction was not mentioned. [Extracted from the article]

A 71-year-old woman with hypertension, hypothyroidism, and bipolar disorder developed agranulocytosis while being treated with clozapine. She presented to the emergency room with symptoms of anorexia and dysuria, and was found to have fever and neutropenia. The woman's clozapine dose had been increased two months prior to admission. Clozapine was discontinued and the patient's neutropenia improved after receiving antibiotic therapy. She was later diagnosed with myelodysplastic syndrome. [Extracted from the article]

A 71-year-old woman with hypertension, hypothyroidism, and bipolar disorder developed agranulocytosis while being treated with clozapine. She presented to the emergency room with symptoms of anorexia and dysuria, and was found to have fever and neutropenia. The woman's clozapine dose had been increased two months prior to admission. Clozapine was discontinued and the patient's neutropenia improved after receiving antibiotic therapy. She was later diagnosed with myelodysplastic syndrome. [Extracted from the article]

A 38-year-old woman with refractory schizophrenia developed agranulocytosis while being treated with clozapine. After 10 years of clozapine treatment, her blood count showed neutropenia and agranulocytosis progression. Clozapine was stopped and she was switched to olanzapine, which restored her hematological values. However, she experienced psychotic decompensation and was restarted on clozapine in combination with olanzapine, resulting in a complete response. During the rechallenge, a decline in absolute neutrophil count was observed but remained within the normal range. [Extracted from the article]

A 48-year-old man with schizophrenia experienced sedation, thinking impairment, sialorrhoea (excessive saliva production), and walking disability while being treated with clozapine and quetiapine. The man had a history of hospitalizations for psychotic episodes but had been asymptomatic since 2013 while on the medication regimen. He denied substance abuse and reported reducing his tobacco use. The symptoms were determined to be a result of the clozapine and quetiapine, and the man's dosage was gradually reduced, leading to the disappearance of the symptoms. He was subsequently discharged. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventIn retrospective study of 50 patients, et al. patient [age and sex not stated] was described, who developed QTc prolongation during antipsychotic therapy with clozapine [route, dosage, duration of treatment to reaction onset and outcome not stated]. The patient received antipsychotic therapy with clozapine. However, the patient was found to developed new QTc prolongation related to clozapine. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventA patient [age and sex not stated] developed pericardial effusion during treatment with clozapine for schizoaffective disorder [route, dosage and duration of treatment to reaction onset not stated].The patient started receiving clozapine for treatment resistant schizoaffective disorder. However, the patient developed pericardial effusion. Later, the treatment with clozapine was stopped [ADR outcome not stated]. [Extracted from the article]

A 46-year-old man developed diarrhea while being treated with clozapine for schizoaffective disorder. He experienced two episodes of severe diarrhea with fever and was admitted to the hospital. Initially, the symptoms were thought to be related to Crohn's disease, but the digestive team later determined that the diarrhea was associated with clozapine. The man's clozapine treatment was stopped, but the outcome of the adverse drug reaction was not mentioned. [Extracted from the article]

A 40-year-old woman experienced cardiac arrest while being treated with clozapine for schizoaffective disorder. The woman had not received the medication for nearly 2 weeks due to issues with her psychiatrist's certification. After restarting her treatment, she experienced cardiac arrest one hour after receiving her first dose of clozapine. Despite attempts at resuscitation, she suffered cerebral hypoxia and shock. [Extracted from the article]

A 45-year-old man with refractory schizophrenia experienced lack of efficacy and pulmonary aspiration while being treated with clozapine. Despite receiving a high dose of clozapine, his schizophrenia remained treatment refractory, leading to the conclusion that clozapine was not effective for him. During electroconvulsive therapy (ECT), he developed a clinical seizure and his vital signs became unstable. It was discovered that he had aspirated partially digested corn, which was consumed more than 20 hours before the ECT. The patient eventually recovered and completed the remaining ECT series after his medications were optimized to improve gastrointestinal hypomotility. [Extracted from the article]

A 26-year-old woman developed myocarditis while being treated with clozapine for bipolar I disorder with psychosis. She presented to the hospital with symptoms such as chills, dyspnea, and chest pain, along with tachycardia and elevated levels of troponin I and C-reactive protein. A cardiac magnetic resonance scan confirmed clozapine-induced myocarditis, and the woman was switched to lurasidone. Treatment with ibuprofen and colchicine led to symptom resolution in two weeks. [Extracted from the article]

A 44-year-old woman developed diffuse large B-cell lymphoma (DLBCL) stage IVX while being treated with clozapine for schizophrenia. The woman had been diagnosed with schizophrenia at the age of 31 and had been receiving clozapine treatment since 2009. She developed cutaneous nodules and other symptoms over a period of several months, leading to a diagnosis of DLBCL stage IVX. She underwent treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, which initially resulted in regression of the lesions. However, a relapse of DLBCL stage IVX was later observed, and she was treated with rituximab plus gemcitabine and oxaliplatin. The DLBCL stage IVX was attributed to the clozapine therapy. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventA 41-year-old man exhibited lack of efficacy during treatment with clozapine for schizophrenia.The man, who had a history of schizophrenia for approximately 18 years, started receiving clozapine 600 mg/day. Despite receiving clozapine, he reported auditory hallucinations. Thus, lack of efficacy to clozapine was considered [route and duration of treatment to reaction onset not stated]. [Extracted from the article]

A 38-year-old man developed myocarditis while being treated with clozapine for antisocial personality disorder and bipolar-type schizoaffective disorder. He experienced new onset cardiac chest pain four weeks after starting the medication. Laboratory tests showed elevated levels of C-reactive protein, troponin-I, and N-terminal B-type natriuretic peptide, as well as eosinophilia. Despite a negative cardiac magnetic resonance imaging (CMR) result, the man was diagnosed with clozapine-induced myocarditis based on his symptoms and other test results. His treatment with clozapine was discontinued, and his condition improved. [Extracted from the article]

A 24-year-old woman with schizoaffective disorder experienced seizures, myocarditis, and DRESS syndrome after taking clozapine and valproate. She had a history of multiple treatments and poor response. After starting clozapine and valproate, she developed seizures, which were treated with clobazam. She also developed a rash and facial swelling, leading to a diagnosis of DRESS syndrome. Clozapine was discontinued, and she later experienced chest tightness and tachycardia, indicating myocarditis. The woman received treatment and showed improvement, but the seizures and myocarditis were attributed to a drug-drug interaction between clozapine and valproate, while the DRESS syndrome was attributed to clozapine. [Extracted from the article]

A 32-year-old man with treatment-resistant schizophrenia developed myocarditis and hepatotoxicity while being treated with clozapine. The man had a history of schizophrenia and had previously been treated with other antipsychotic medications. He was admitted to the hospital and started on clozapine, with the dose gradually increased. On day 13 of treatment, he developed a sudden fever and further tests revealed myocarditis. The clozapine was discontinued and blood tests later showed increased liver enzyme levels, leading to a diagnosis of clozapine-induced hepatotoxicity. The decision was made not to re-treat him with clozapine. [Extracted from the article]

An 85-year-old man experienced thrombocytopenia and sialorrhoea while being treated with clozapine for Parkinson's disease, and developed dyskinesia while being treated with levodopa. He had a history of Parkinson's disease, REM sleep behavior disorder, prostate cancer, and constipation. The man had been taking multiple medications, including clozapine and levodopa, for his Parkinson's disease. The thrombocytopenia was determined to be a side effect of clozapine, and the sialorrhoea was considered to be a result of the clozapine therapy. The man's condition was being monitored, and he was referred to a hematologist to rule out other causes of thrombocytopenia. [Extracted from the article]

A case report published in Reactions Weekly describes a woman in her 40s who developed Pemphigus vulgaris, a rare autoimmune disorder, while being treated with clozapine for schizophrenia. The woman had a history of violent behavior and had been hospitalized multiple times. After starting clozapine, she experienced stomatitis and later developed erosions on her tongue and vulva. The diagnosis of Pemphigus vulgaris was confirmed, and the woman received treatment with methylprednisolone and immunoglobulin therapy. Her symptoms improved, and the clozapine dosage was increased without recurrence of Pemphigus vulgaris. This is the first reported case of this side effect associated with clozapine. [Extracted from the article]

A 57-year-old woman with schizophrenia experienced tonic-clonic seizures after overdosing on clozapine, a medication used to treat the condition. The overdose was discovered when the woman abruptly stopped smoking during her hospitalization for a bone fracture. The woman was admitted to the emergency room in a drowsy state with unresponsive pupils and low oxygen levels. She was treated with clonazepam and her seizures resolved. The dose of clozapine was subsequently reduced. [Extracted from the article]

A 53-year-old woman with schizoaffective disorder developed lithium toxicity in the form of catatonia while being treated with lithium. She also showed a lack of efficacy when treated with clozapine and lorazepam for the lithium toxicity. The woman received treatment with lorazepam, but it had limited effect in improving her catatonia. Electroconvulsive therapy (ECT) was consulted and pursued, resulting in mild improvements. However, she later entered a catatonic state and did not respond to clozapine and lorazepam. ECT was pursued again, and after receiving seven treatments, she was able to start eating, fulfilling her own needs, and ambulating. She was then transferred to a psychiatric hospital to stabilize her psychosis. [Extracted from the article]

In a retrospective study, two pediatric patients, a 13-year-old boy and a 13-year-old girl, died from acute drug poisoning after overdosing on clozapine, difenidol, or fluvoxamine. One patient consumed an overdose of oral clozapine along with heavy drinking, while the other patient overdosed on oral difenidol and oral fluvoxamine. Both patients experienced acute drug poisoning as a result of their treatments and unfortunately died as a result of the drug overdose. [Extracted from the article]