Clozapine


Dibenzodiazepine used as an alternative treatment for refractory psychotic patients.
 
Incidence
0.05%.
 
Clinical manifestations
Urticarial rash (maculopapular, erythematous and confluent) involving face, neck, trunk
 
Photosensitivity.
 
Parotitis.
 
Agranulocytosis.
 
Myocarditis.
 
Diagnostic methods
Lymphocyte transformation test: one positive case in a patient with parotitis.
 
Mechanisms
Unknown.
 
Management
Avoidance.
 
Cross-reactivity with chlorpromazine may occur.

References

  1. Kuintana J, Shah B, Guze B, "Clozapine-chlorpromazine allergic cross-reactivity in a psychotic patient with asymptomatic AIDS", Biol. Psychiatry., 1996; 40 (11): 1185-6
  2. Hinze-Selch D, Becker E.W, Stein G, Schreiber W, Pollmacher T, "Clozapine-induced parotitis: an immunological cause ?", Am. J. Psychiatry., 1996; 153 (6): 840
  3. Howanitz E, Pardo M, Losonczy M, "Photosensitivity to clozapine", J. Clin. Psychiatry., 1995; 56 (12): 589
  4. Goumemiouk A.D, Ancill R.J, Mac Ewan G.W, "A case of drug interaction involving clozapine", Can. J. Psychiatry, 1991; 36: 234

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.