Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction
Joint Authors
Meyer, Jonathan M.
Proctor, George
Cummings, Michael A.
Dardashti, Laura J.
Stahl, Stephen M.
Source
Issue
Vol. 2016, Issue 2016 (31 Dec. 2016), pp.1-7, 7 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2016-10-30
Country of Publication
Egypt
No. of Pages
7
Main Subjects
Abstract EN
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.
American Psychological Association (APA)
Meyer, Jonathan M.& Proctor, George& Cummings, Michael A.& Dardashti, Laura J.& Stahl, Stephen M.. 2016. Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction. Case Reports in Psychiatry،Vol. 2016, no. 2016, pp.1-7.
https://search.emarefa.net/detail/BIM-1102497
Modern Language Association (MLA)
Meyer, Jonathan M.…[et al.]. Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction. Case Reports in Psychiatry No. 2016 (2016), pp.1-7.
https://search.emarefa.net/detail/BIM-1102497
American Medical Association (AMA)
Meyer, Jonathan M.& Proctor, George& Cummings, Michael A.& Dardashti, Laura J.& Stahl, Stephen M.. Ciprofloxacin and Clozapine: A Potentially Fatal but Underappreciated Interaction. Case Reports in Psychiatry. 2016. Vol. 2016, no. 2016, pp.1-7.
https://search.emarefa.net/detail/BIM-1102497
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1102497