Clozapine-Induced Severe Toxicity: Exploring the Pharmacokinetic Profile of Clozapine and Its Significance in Hemodynamic Instability – A Case Report

Abstract

Hemodynamic instability in patients with clozapine intoxication can indirectly reflect the serum concentration of clozapine.We have described a case of a 32-year-old pregnant woman who developed life-threatening clozapine toxicity at 28 weeks of gestation. The levels of clozapine and norclozapine in the serum were high. We initiated hemoperfusion(HP) and other detoxification therapies to remove the drug. The patient had severely dilated peripheral blood vessels, which led to cardiac symptoms such as fatal hypotension and uncontrollable tachycardia, resulting in very high cardiac output and elevated Central venous oxygen saturation (ScvO2). Pharmacological intervention significantly improved the hemodynamics.In light of our observations in the ongoing case, we posit that evaluating hemodynamic parameters before and after blood detoxification could serve as a valuable means to gauge effectiveness and provide guidance for treatment.

Keywords:

• clozapine
• toxicity
• pulse index continuous cardiac output
• PICCO
• hemoperfusion
• HP

Abbreviations

ICU, intensive care unit; ScvO₂, Central venous oxygen saturation; PICCO, Pulse index continuous cardiac output; CI, cardiac index; CVP, central venous pressure; GEDI, global end diastolic volume index; GEF, global ejection fraction; ITBVI, intrapleural blood volume index; EVLWI, extravascular lung water index; SVRI, systemic vascular resistance index; VDI, vasopressor dependency index; HP, Hemoperfusion; CVVH, continuous veno-venous hemofiltration; PE, Plasma exchange.

Data Sharing Statement

Patient data supporting the results reported in the article can be obtained from the corresponding author by email.

Ethics Approval and Consent to Participate

The patient ‘s husband (Patient with paranoid schizophrenia) has given his written informed consent for the publication of de-identified case information regarding the patient ‘s medical condition and its management.

Consent for Publication

The patient’s husband, who is the legal representative of the patient with paranoid schizophrenia, has provided written informed consent for the publication of de-identified case information regarding the patient’s medical condition and its management. Institutional approval is not required as the patient is an existing patient and informed consent has been obtained.

Acknowledgments

The authors are grateful to all doctors and nurses who have participated in Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, P.R.China.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; ZXY took part in drafting, revising or critically reviewing the article; QG gave final approval of the version to be published; DJD have agreed on the journal to which the article has been submitted; MKC and YP agree to be accountable for all aspects of the work. Additionally, all authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors received no funding to support this publication.