Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction
Objective. Clozapine provides a 50%–60% response rate in refractory schizophrenia but has a narrow therapeutic index and is susceptible to pharmacokinetic interactions, particularly with strong inhibitors or inducers of cytochrome P450 (CYP) 1A2. Case Report. We report the case of a 28-year-old nons...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Psychiatry |
| Online Access: | http://dx.doi.org/10.1155/2016/5606098 |
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| _version_ | 1832560525503889408 |
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| author | Jonathan M. Meyer George Proctor Michael A. Cummings Laura J. Dardashti Stephen M. Stahl |
| author_facet | Jonathan M. Meyer George Proctor Michael A. Cummings Laura J. Dardashti Stephen M. Stahl |
| author_sort | Jonathan M. Meyer |
| collection | DOAJ |
| description | Objective. Clozapine provides a 50%–60% response rate in refractory schizophrenia but has a narrow therapeutic index and is susceptible to pharmacokinetic interactions, particularly with strong inhibitors or inducers of cytochrome P450 (CYP) 1A2. Case Report. We report the case of a 28-year-old nonsmoking female with intellectual disability who was maintained for 3 years on clozapine 100 mg orally twice daily. The patient was treated for presumptive urinary tract infection with ciprofloxacin 500 mg orally twice daily and two days later collapsed and died despite resuscitation efforts. The postmortem femoral clozapine plasma level was dramatically elevated at 2900 ng/mL, and the cause of death was listed as acute clozapine toxicity. Conclusion. Given the potentially fatal pharmacokinetic interaction between clozapine and ciprofloxacin, clinicians are advised to monitor baseline clozapine levels prior to adding strong CYP450 1A2 inhibitors, reduce the clozapine dose by at least two-thirds if adding a 1A2 inhibitor such as ciprofloxacin, check subsequent steady state clozapine levels, and adjust the clozapine dose to maintain levels close to those obtained at baseline. |
| format | Article |
| id | doaj-art-6cf0993c3e3e4130baa515616be55d3b |
| institution | Kabale University |
| issn | 2090-682X 2090-6838 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Psychiatry |
| spelling | doaj-art-6cf0993c3e3e4130baa515616be55d3b2025-02-03T01:27:16ZengWileyCase Reports in Psychiatry2090-682X2090-68382016-01-01201610.1155/2016/56060985606098Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated InteractionJonathan M. Meyer0George Proctor1Michael A. Cummings2Laura J. Dardashti3Stephen M. Stahl4Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USACalifornia Department of State Hospitals (DSH), Psychopharmacology Resource Network, 3102 East Highland Avenue, Patton, CA 92369, USACalifornia Department of State Hospitals (DSH), Psychopharmacology Resource Network, 3102 East Highland Avenue, Patton, CA 92369, USACalifornia Department of State Hospitals (DSH), Clinical Operations Advisory Council, Bateson Building, 1600 9th Street, Room 400, Sacramento, CA 95814, USADepartment of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USAObjective. Clozapine provides a 50%–60% response rate in refractory schizophrenia but has a narrow therapeutic index and is susceptible to pharmacokinetic interactions, particularly with strong inhibitors or inducers of cytochrome P450 (CYP) 1A2. Case Report. We report the case of a 28-year-old nonsmoking female with intellectual disability who was maintained for 3 years on clozapine 100 mg orally twice daily. The patient was treated for presumptive urinary tract infection with ciprofloxacin 500 mg orally twice daily and two days later collapsed and died despite resuscitation efforts. The postmortem femoral clozapine plasma level was dramatically elevated at 2900 ng/mL, and the cause of death was listed as acute clozapine toxicity. Conclusion. Given the potentially fatal pharmacokinetic interaction between clozapine and ciprofloxacin, clinicians are advised to monitor baseline clozapine levels prior to adding strong CYP450 1A2 inhibitors, reduce the clozapine dose by at least two-thirds if adding a 1A2 inhibitor such as ciprofloxacin, check subsequent steady state clozapine levels, and adjust the clozapine dose to maintain levels close to those obtained at baseline.http://dx.doi.org/10.1155/2016/5606098 |
| spellingShingle | Jonathan M. Meyer George Proctor Michael A. Cummings Laura J. Dardashti Stephen M. Stahl Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction Case Reports in Psychiatry |
| title | Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction |
| title_full | Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction |
| title_fullStr | Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction |
| title_full_unstemmed | Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction |
| title_short | Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction |
| title_sort | ciprofloxacin and clozapine a potentially fatal but underappreciated interaction |
| url | http://dx.doi.org/10.1155/2016/5606098 |
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