The use of clozapine and clonazepam co-administration in the treatment of a severe tardive dyskinesia: A case report

Abstract

This is a case report of a patient who was treated with clozapine and clonazepam after he developed neuroleptic-induced tardive dyskinesia following treatment for schizophrenia. There are reports of clozapine treatment itself causing tardive dyskinesia; however, more reports have shown clozapine’s benefit for patients with neuroleptic-induced tardive dyskinesia. This is a case report of a patient with neuroleptic-induced tardive dyskinesia who benefitted from clozapine treatment with adjuvant use of clonazepam – the first such case report from Ethiopia. A 43-year-old male patient developed severe involuntary abnormal body movements mainly involving the trunk after he received chlorpromazine for 8 years for the diagnosis of schizophrenia. When the movement disorder became intolerable and disabling, the diagnosis of severe neuroleptic-induced tardive dyskinesia was established and the patient was started on clozapine with adjuvant clonazepam treatment. Following such management, the patient responded well and the dyskinetic movements were fully controlled, and the patient was able to work. Patients with severe and disabling neuroleptic-induced tardive dyskinesia can be treated and be productive if they receive treatment with clozapine, with adjuvant use of clonazepam.

A Case Report of Excessive Use of Clozapine Combined With Clonazepam

“…For patients with schizophrenia, CLZ is sometimes combined with CLNAZ, and the combination of the two can also help prevent the occurrence of tardive dyskinesia (TD) ( 23 ). In addition, some studies have also shown that increasing the use of CLNAZ can help improve the efficacy of CLZ and relieve anxiety symptoms in patients with schizophrenia ( 24 ). However, in the study conducted by Jiang P, they found that the combination of CLNAZ and CLZ can cause changes in blood CLZ and N-CLZ concentrations, and patients must increase the dose of CLZ to achieve satisfactory results ( 7 ).…”

Tardive Myoclonus Responsive to Clozapine Misdiagnosed as Restless Leg Syndrome

“…17,18 Although clozapine monotherapy seems to be effective in terms of improving the movements associated with tardive dystonia, 19 some reports recommend the use of clozapine alongside other medications such as clonazepam. 17 In addition, there are studies indicating that clozapine can also cause tardive dyskinesia. 20 In conclusion, as evidenced by the improvement experienced by our patient, clozapine monotherapy could be a valuable agent for the treatment of TM and other TS in patients diagnosed with schizophrenia.…”

“…Although the mechanism behind clozapine's efficacy in relation to the treatment of TS is not yet fully understood, it has been suggested that clozapine works by acting on the changes that are induced in the brain's striatal system by the prolonged blockade of dopamine receptors as a result of the long-term use of antipsychotic medications 17,18 . Although clozapine monotherapy seems to be effective in terms of improving the movements associated with tardive dystonia, 19 some reports recommend the use of clozapine alongside other medications such as clonazepam 17 . In addition, there are studies indicating that clozapine can also cause tardive dyskinesia 20 …”

Drug-induced dyskinesias, can they be prevented?

“…Doctors tried to discontinue the current treatment and introduced the following drugs gradually: olanzapine, clozapine and clonazepam. This was the use of clozapine at a dose of 500 mg / day and clonazepam at a dose of 4 mg / day that gave a noticeable improvement, and the dyskinetic movements almost completely disappeared [8].…”

“…Lekarze podjęli próbę odstawienia dotychczasowego leczenia i włączenia stopniowo następujących leków: olanzapiny, klozapiny oraz klonazepamu. To właśnie zastosowanie klozapiny w dawce 500mg/dobę oraz klonazepamu w dawce 4mg/dobę dało zauważalną poprawę, a ruchy dyskinetyczne prawie całkowicie zniknęły [8].…”