Clozapine-Induced Fevers and 1-Year Clozapine Discontinuation Rate

Tham, Joseph; Dickson, R. A.

doi:10.4088/jcp.v63n1005

Cited by 47 publications

(52 citation statements)

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“…fever, tachycardia and fatigue) are common during clozapine treatment. Fever has been reported in 20% of patients commencing treatment with clozapine (Tham and Dickson, 2002), and it is often regarded as a benign, self-limiting phenomenon. However, pyrexia may herald the onset of clozapine-induced myocarditis and patients developing a fever, particularly within the first 2-3 weeks of commencing clozapine treatment, warrant further investigation and careful monitoring.…”

Section: Clinical Featuresmentioning

confidence: 99%

Cardiac side effects of psychiatric drugs

Mackin

2007

Hum. Psychopharmacol. Clin. Exp.

139

117

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Section: Clinical Featuresmentioning

confidence: 99%

Cardiac side effects of psychiatric drugs

Mackin

2007

Hum. Psychopharmacol. Clin. Exp.

139

117

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“…Clozapine-induced fever is a commonly reported phenomenon, [10][11][12] which often occurs within the first 4 weeks of treatment initiation. [10][11][12] The incidence of clozapine-induced fever varied widely from 0.5% to 50%, 4,10-16 depending on the study methodology.…”

mentioning

confidence: 99%

The Incidence and Characteristics of Clozapine-Induced Fever in a Local Psychiatric Unit in Hong Kong

et al. 2008

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Objective: To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit. Method: A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever. Results: Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8 °C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02). Conclusion: Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.

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“…Low-grade fever is thought to occur in up to 20% of the patients commencing treatment with clozapine and is considered a benign, self-limiting phenomenon. 17 Isolated tachycardia is also very common in early stages of treatment and also could be benign.…”

Section: Discussionmentioning

confidence: 99%