Clozapine is used in combination with psychotropic medication and a wide variety of non-psychotropic medications. This article reviews the literature on clozapine drug interactions and the effect these have on serum level changes in clozapine. A total of 54 articles with a total of 109 individual case reports were obtained by manual and computerised literature search from January 1970 to May 2013. Psychotropic medications most likely to increase clozapine levels include: fluvoxamine, lamotrigine, aripiprazole and the discontinuation of levomepromazine and carbamazepine. Non-psychotropic medications associated with increase in clozapine levels include: erythromycin, ciprofloxacin, omeprazole, cimetidine, OCP containing ethinylestradiol, amiodarone, aluminum hydroxide and isoniazid. Rifampin and St John's wort resulted in low clozapine levels. Smoking cessation also increased clozapine levels. The role of routine clozapine monitoring in clinical practice requires further clarification. In the absence of recommendations for routine clozapine level monitoring, clinical judgment should always be used in addition to diagnostic testing. Clinicians must maintain increased clinical vigilance for adverse side effects when clozapine is combined with other medications.
Background: Cardiovascular causes contribute towards the large proportion of increased morbidity and mortality,in patients ofChronic renal failure. Cardiac disease is the major cause of death in dialysis population. Methods: The present study was undertaken for documentation of various cardiovascular abnormalities in sixty patients with Chronic Kidney Disease at Government Medical College Patiala, using Electrocardiography and Echocardiography as investigation procedures.The present study is a descriptive -cross sectional study and data collected was analysed by frequency, percentage, chi-square test and by using p value. Results: ECG was normal in 15 out of 60 cases of CKD(25%), LVH present in 20 out of 60(33.33%), Left axis deviation in 9 out of 60(15%), Conduction disturbances in 10 out of 60(16.67%), Ischemia in 12 out of 60(20%), Arrhythmias in 2 out of 60(3.33%) and P-mitrale was found in 4 out of 60 cases(6.67%). The most common ECG change associated with cases with CKD was LVH (33.33%).The most common abnormality found on echo in CKD cases under study was LVH(56.67%) followed by Diastolic Dysfunction(38.33%). Conclusion: Left ventricular hypertrophy is the commonest abnormality observed in CKD both on ECG and Echocardiography. Echocardiography is a more sensitive diagnostic procedure to detect left ventricular hypertrophy. After LVH most common abnormality found on Echocardiography is Left ventricular diastolic dysfunction. Pericardial effusion and conduction abnormalities are more common in patients of CKD on hemodialysis.
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