Death From COVID-19 in a Patient Receiving Clozapine

Llesuy, Joan Roig; Sidelnik, S. Alex

doi:10.4088/pcc.20l02699

Cited by 9 publications

(3 citation statements)

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Section: Resultsmentioning

confidence: 99%

“…Llesuy et al 20 reported a case of a patient who was taking clozapine and developed severe lymphopenia while he had COVID-19; Dotson et al 23 reported 3 cases of clozapine toxicity symptoms in COVID-19 infected patients; in 1 case, neutropenia was also reported. Another case report presented a patient who experienced clozapine toxicity and has abruptly stopped clozapine and subsequently suffered a severe relapse of psychotic symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…Toxicity symptoms may be difficult to differentiate from those of COVID-19 infection: sedation, change in the consciousness level, speech impairment, hypersalivation, fever, vomiting, myoclonus, delirium, and even seizures. 19,20 Inflammation-associated increase in clozapine plasma level is variable, with a median clozapine level increase of 48% when inflammation is present (C-reactive protein $ 5 mg/L). 21 Llesuy et al 20 reported a case of a patient who was taking clozapine and developed severe lymphopenia while he had COVID-19; Dotson et al 23 reported 3 cases of clozapine toxicity symptoms in COVID-19 infected patients; in 1 case, neutropenia was also reported.…”

Section: Resultsmentioning

confidence: 99%

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Neutropenia in Patients With Clozapine-Treated Schizophrenia: An Effect of Clozapine or a Consequence of SARS-CoV-2 Infection? A Systematic Review

Moga

Teodorescu

Dragan³

et al. 2022

American Journal of Therapeutics

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Background: Clozapine is the only approved antipsychotic for treatment-resistant schizophrenia. Despite its therapeutic benefits, it is still widely underused, mainly because of its potential to cause agranulocytosis and neutropenia. Prescribing clozapine in COVID-19-positive patients became more challenging because of this potential side effect. This article is a review of literature on the risk of neutropenia associated with clozapine treatment in patients with COVID-19. Areas of Uncertainty:In clozapine-treated COVID-19-positive patients, neutropenia was reported in some cases; is it a consequence of clozapine treatment or of SARS-Co2 infection?Data Sources: Data were extracted from 2 databases: PubMed/MEDLINE and Google Scholar. We selected all original reports, from March 2020 until May 2022, on neutropenia associated with clozapine treatment in positive COVID-19 patients. Eleven studies were selected for the final analysis.Therapeutic Advances: Before the COVID-19 pandemic, neutropenia in clozapine-treated patients was reported in 3.8% of cases. During the pandemic, neutropenia rates seemed to be higher. As per the cause of neutropenia, studies reported contradictory results. We aim to clarify rates and causes of neutropenia in clozapine-treated COVID-19-positive patients.Results: Three hundred eighty-eight articles were initially selected from the 2 databases. After excluding duplicates, unrelated articles, reviews, and guidelines, 11 studies were analyzed, all centered on clozapine treatment, COVID-19 infection, and associated neutropenia.Conclusions: Clozapine treatment in COVID-19-positive patients may be associated with a transient reduction of absolute neutrophils count, in some cases reaching neutropenia levels. Neutropenia rates reported in SARS-CoV-2-infected patients are higher than the prepandemic reports; therefore, we assume that the cause might be a result of the immunological interference between clozapine and SARS-CoV-2. Clozapine treatment needs to be continued whenever possible, with dose adjustments in relation to blood test results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Neutropenia in Patients With Clozapine-Treated Schizophrenia: An Effect of Clozapine or a Consequence of SARS-CoV-2 Infection? A Systematic Review

Moga

Teodorescu

Dragan³

et al. 2022

American Journal of Therapeutics

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Clozapine/quetiapine

2020

Reactions Weekly

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Psychotropics and COVID-19: An analysis of safety and prophylaxis

et al. 2021

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The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19, therefore herein we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications, (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.

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Death From COVID-19 in a Patient Receiving Clozapine

Cited by 9 publications

References 0 publications

Neutropenia in Patients With Clozapine-Treated Schizophrenia: An Effect of Clozapine or a Consequence of SARS-CoV-2 Infection? A Systematic Review

Neutropenia in Patients With Clozapine-Treated Schizophrenia: An Effect of Clozapine or a Consequence of SARS-CoV-2 Infection? A Systematic Review

Clozapine/quetiapine

Psychotropics and COVID-19: An analysis of safety and prophylaxis

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