Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms
A 59-year-old woman was admitted to a tertiary care refractory psychosis unit with a referral diagnosis of schizoaffective disorder. She was maintained on 400 mg of clozapine once daily as part of her pre-existing treatment for auditory hallucinations. The steady state plasma concentrations of cloza...
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| Veröffentlicht in: | Journal of psychiatry & neuroscience 2016-07, Vol.41 (4), p.E67-E68 |
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| creator | Lee, Lik Hang N White, Randall F Barr, Alasdair M Honer, William G Procyshyn, Ric M |
| description | A 59-year-old woman was admitted to a tertiary care refractory psychosis unit with a referral diagnosis of schizoaffective disorder. She was maintained on 400 mg of clozapine once daily as part of her pre-existing treatment for auditory hallucinations. The steady state plasma concentrations of clozapine and norclozapine were 2542 and 1465 nmol/L, respectively. Several cytokines involved in the acute inflammatory response have been identified as having an inhibitory effect on the expression of certain drug metabolizing enzymes. UTI-associated increases in the plasma concentrations of clozapine and norclozapine are most readily explained by the actions of cytokines on drug metabolism and/or protein binding. Since we could not readily order plasma concentrations of unbound clozapine or α1-acid glycoprotein, confirmation of the underlying mechanism was not possible. As such, clinicians should monitor for clozapineassociated adverse effects and adjust the dosage accordingly. |
| doi_str_mv | 10.1503/jpn.150156 |
| format | Article |
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She was maintained on 400 mg of clozapine once daily as part of her pre-existing treatment for auditory hallucinations. The steady state plasma concentrations of clozapine and norclozapine were 2542 and 1465 nmol/L, respectively. Several cytokines involved in the acute inflammatory response have been identified as having an inhibitory effect on the expression of certain drug metabolizing enzymes. UTI-associated increases in the plasma concentrations of clozapine and norclozapine are most readily explained by the actions of cytokines on drug metabolism and/or protein binding. Since we could not readily order plasma concentrations of unbound clozapine or α1-acid glycoprotein, confirmation of the underlying mechanism was not possible. As such, clinicians should monitor for clozapineassociated adverse effects and adjust the dosage accordingly.</description><identifier>ISSN: 1180-4882</identifier><identifier>EISSN: 1488-2434</identifier><identifier>DOI: 10.1503/jpn.150156</identifier><identifier>PMID: 27332768</identifier><identifier>CODEN: JPNEEF</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Antipsychotic Agents - blood ; Antipsychotic Agents - therapeutic use ; Case studies ; Clozapine ; Clozapine - blood ; Clozapine - therapeutic use ; Complications and side effects ; Cytokines ; Diagnosis ; Enzymes ; Female ; Humans ; Mental health ; Metabolism ; Middle Aged ; Plasma ; Psychopharmacology for the Clinician ; Psychosis ; Psychotic Disorders - blood ; Psychotic Disorders - complications ; Psychotic Disorders - drug therapy ; Urinary tract diseases ; Urinary tract infections ; Urinary Tract Infections - blood ; Urinary Tract Infections - complications ; Urinary Tract Infections - diagnosis ; Urinary Tract Infections - drug therapy ; Urogenital system</subject><ispartof>Journal of psychiatry & neuroscience, 2016-07, Vol.41 (4), p.E67-E68</ispartof><rights>COPYRIGHT 2016 Joule Inc.</rights><rights>Copyright 8872147 Canada Inc. Jul 2016</rights><rights>2016 Joule Inc. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c901t-40f1065329a5e24e5d5912fa78b3f68306674c4ab7e6e023cc6a5dd1467f34743</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915939/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915939/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27332768$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Lik Hang N</creatorcontrib><creatorcontrib>White, Randall F</creatorcontrib><creatorcontrib>Barr, Alasdair M</creatorcontrib><creatorcontrib>Honer, William G</creatorcontrib><creatorcontrib>Procyshyn, Ric M</creatorcontrib><title>Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms</title><title>Journal of psychiatry & neuroscience</title><addtitle>J Psychiatry Neurosci</addtitle><description>A 59-year-old woman was admitted to a tertiary care refractory psychosis unit with a referral diagnosis of schizoaffective disorder. She was maintained on 400 mg of clozapine once daily as part of her pre-existing treatment for auditory hallucinations. The steady state plasma concentrations of clozapine and norclozapine were 2542 and 1465 nmol/L, respectively. Several cytokines involved in the acute inflammatory response have been identified as having an inhibitory effect on the expression of certain drug metabolizing enzymes. UTI-associated increases in the plasma concentrations of clozapine and norclozapine are most readily explained by the actions of cytokines on drug metabolism and/or protein binding. Since we could not readily order plasma concentrations of unbound clozapine or α1-acid glycoprotein, confirmation of the underlying mechanism was not possible. As such, clinicians should monitor for clozapineassociated adverse effects and adjust the dosage accordingly.</description><subject>Antipsychotic Agents - blood</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Case studies</subject><subject>Clozapine</subject><subject>Clozapine - blood</subject><subject>Clozapine - therapeutic use</subject><subject>Complications and side effects</subject><subject>Cytokines</subject><subject>Diagnosis</subject><subject>Enzymes</subject><subject>Female</subject><subject>Humans</subject><subject>Mental health</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Plasma</subject><subject>Psychopharmacology for the Clinician</subject><subject>Psychosis</subject><subject>Psychotic Disorders - blood</subject><subject>Psychotic Disorders - complications</subject><subject>Psychotic Disorders - drug therapy</subject><subject>Urinary tract diseases</subject><subject>Urinary tract infections</subject><subject>Urinary Tract Infections - blood</subject><subject>Urinary Tract Infections - complications</subject><subject>Urinary Tract Infections - diagnosis</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urogenital system</subject><issn>1180-4882</issn><issn>1488-2434</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqVlFuL1DAUgIso7rr64g-Q4oKo0DVpLm19EJZl1YVlBS_PIZOezmRok26TLuqvN3HWYSoDM0MfmtN--XLOgZwkeY7RGWaIvFv2Ji4w4w-SY0zLMsspoQ_DGpcoC3F-lDxxbokQygP1ODnKC0LygpfHibps4U56qFPV2t-y1wbSvpWuk6myRoHxg_TamtRBiGs5_Eq9TWU6Dtr8DQapfKpNAypi79N-sL11wdeBWkijXeeeJo8a2Tp4dv8-SX58vPx-8Tm7_vLp6uL8OlMVwj6jqMGIM5JXkkFOgdWswnkji3JGGl4SxHlBFZWzAjignCjFJatrTHnREFpQcpJ8WHn7cdZBvUq-Ff2gu5CqsFKL6R-jF2Ju7wStMKtIFQSv7wWDvR3BedFpp6BtpQE7OhHaWXKGCSO70aKqGM9RFdM6_Q9d2nEwoRNRSKtQSqhuTc1lCyI01MbWRqk4p4wXrCShN_tQMblsCzUHA6Fqa6DR4fPEeggf_S-38KrXt2JTuhOKprMtUHhq6LTamupBG-IJbyYbAuPhp5_L0Tlx9e3rVL4vu9N7c4D3Zup9tcEuQLZ-4Ww7xtvlptK9wGh8uwLVYJ0boFnfCIxEHCAiDBCxGiABfrF5h9bov4lB_gDN7GDr</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Lee, Lik Hang N</creator><creator>White, Randall F</creator><creator>Barr, Alasdair M</creator><creator>Honer, William G</creator><creator>Procyshyn, Ric M</creator><general>Joule Inc</general><general>CMA Impact, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160701</creationdate><title>Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms</title><author>Lee, Lik Hang N ; White, Randall F ; Barr, Alasdair M ; Honer, William G ; Procyshyn, Ric M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c901t-40f1065329a5e24e5d5912fa78b3f68306674c4ab7e6e023cc6a5dd1467f34743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Antipsychotic Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of psychiatry & neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Lik Hang N</au><au>White, Randall F</au><au>Barr, Alasdair M</au><au>Honer, William G</au><au>Procyshyn, Ric M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms</atitle><jtitle>Journal of psychiatry & neuroscience</jtitle><addtitle>J Psychiatry Neurosci</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>41</volume><issue>4</issue><spage>E67</spage><epage>E68</epage><pages>E67-E68</pages><issn>1180-4882</issn><eissn>1488-2434</eissn><coden>JPNEEF</coden><abstract>A 59-year-old woman was admitted to a tertiary care refractory psychosis unit with a referral diagnosis of schizoaffective disorder. She was maintained on 400 mg of clozapine once daily as part of her pre-existing treatment for auditory hallucinations. The steady state plasma concentrations of clozapine and norclozapine were 2542 and 1465 nmol/L, respectively. Several cytokines involved in the acute inflammatory response have been identified as having an inhibitory effect on the expression of certain drug metabolizing enzymes. UTI-associated increases in the plasma concentrations of clozapine and norclozapine are most readily explained by the actions of cytokines on drug metabolism and/or protein binding. Since we could not readily order plasma concentrations of unbound clozapine or α1-acid glycoprotein, confirmation of the underlying mechanism was not possible. As such, clinicians should monitor for clozapineassociated adverse effects and adjust the dosage accordingly.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>27332768</pmid><doi>10.1503/jpn.150156</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Antipsychotic Agents - blood Antipsychotic Agents - therapeutic use Case studies Clozapine Clozapine - blood Clozapine - therapeutic use Complications and side effects Cytokines Diagnosis Enzymes Female Humans Mental health Metabolism Middle Aged Plasma Psychopharmacology for the Clinician Psychosis Psychotic Disorders - blood Psychotic Disorders - complications Psychotic Disorders - drug therapy Urinary tract diseases Urinary tract infections Urinary Tract Infections - blood Urinary Tract Infections - complications Urinary Tract Infections - diagnosis Urinary Tract Infections - drug therapy Urogenital system |
| title | Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms |
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