Clozapine Withdrawal Symptoms after Change to Sertindole in a Schizophrenic Patient

Abstract

A 30-year-old male patient with paranoid schizophrenia was on clozapine therapy for more than five years. Discontinuation of clozapine and an attempt to change his medication to sertindole has led to serious psychotic and somatic symptoms. After readministration of clozapine the psychotic symptoms rapidly disappeared. The patient was monitored by BPRS and PANSS positive and negative scale. Also clinical and labor parameters of the patient were monitored. The change of his medication from clozapine to sertindole was unsuccessful. This case report suggests that although atypical antipsychotics may be generally different from the classical neuroleptic drugs, there are also significant differences among the atypical antipsychotic drugs in their effects on the receptors of the central nervous system. Therefore the change of clozapine to another atypical antipsychotic medication in the clinical practice should be cross-tapered and the symptoms of withdrawal closely monitored.

Combination of ziprasidone and clozapine in treatment‐resistant schizophrenia

“…Ziprasidone, on the other hand, was well tolerated, improved mood and negative symptoms, but signs of a psychotic exacerbation occurred. Tapering off clozapine may lead to a withdrawal syndrome (Berecz et al, 2000;Shiovitz et al, 1996). Considering this danger we cross-tapered, reducing the clozapine dose slowly without noting typical somatic symptoms, extrapyramidal motoric dysfunction or psychotic symptoms within the critical time window.…”

Elective Withdrawal from Clozapine

“…The dangers of abruptly withdrawing clozapine have been extensively reported (see Goudie [1] and Moncrieff [2]) but official advice concerning elective withdrawal (Approved Clozaril product information; Novartis Pharmaceuticals Australia, amended 12 June 2009) is simply that, in ‘planned termination’ of clozapine, ‘reducing the dose gradually over one to two weeks is recommended’. Previously (Stanitta et al [3] and Berecz et al [4]) suggested cross-tapering clozapine with an alternative antipsychotic over a few weeks.…”