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Clozapine treatment during the COVID-19 pandemic

Published online by Cambridge University Press:  13 August 2021

E. Dąbrowska ,
B. Galińska-Skok ,
D. Zalewski  and
A. Nobis
E. Dąbrowska*
Affiliation:
Department Of Psychiatry, Medical University of Bialystok, Choroszcz, Poland
B. Galińska-Skok
Affiliation:
Department Of Psychiatry, Medical University of Bialystok, Choroszcz, Poland
D. Zalewski
Affiliation:
Department Of Psychiatry, Medical University of Bialystok, Choroszcz, Poland
A. Nobis
Affiliation:
Department Of Psychiatry, Medical University of Bialystok, Choroszcz, Poland
*
*Corresponding author.

Abstract

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Introduction

Clozapine is an effective antipsychotic used in treatment-resistant schizophrenia. One of the serious complications of clozapine therapy is agranulocytosis, therefore regular monitoring of the level of white blood cells (WBC) in plasma is necessary. During acute inflammatory infections, including the COVID-19 infection, levels of clozapine may increase, by the CYP 450 system, leading to adverse effects such as sedation, hypersalivation and consequently to aspiration pneumonia.

Objectives

The aim of the study is to assess the validity of continuing clozapine treatment during the COVID-19 pandemic.

Methods

Brief literature review, based on research of scientific articles published in PubMed, using as keywords the terms “clozapine” and “COVID-19”.

Results

Research studies indicate that SARS-COV2 infection in patients treated with clozapine does not significantly reduce the level of neutrophils, despite commonly observed leucopenia with lymphopenia. Due to pandemic, existing WBC scheme has been modified with a trend towards less frequent measurements. To minimize the side effects of clozapine during infection, it is recommended to reduce the dose of clozapine by half and continue lower dose until 3 days after fever has subsided. Additionally, there have been reports of psychosis recurrence after discontinuation of clozapine causing difficulties in treatment COVID-19 as also comorbid mental disease.

Conclusions

Treatment of clozapine is associated with higher risk of COVID-19 complications and at the same time COVID-19 infection may increase clozapine toxicity. Therefore, the risks of COVID-19 infection present a challenge for safe clozapine use. Further research will be needed to assess these dependencies and strategies.

Disclosure

No significant relationships.

Keywords

COVID-19treatment-resistent schizophreniaclozapinecoronavirus
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S669 - S670
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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