Unsuccessful Reexposure to Clozapine

Loxapine and Cyproheptadine Combined Limit Clozapine Rebound Psychosis and May Also Predict Clozapine Response

“…Although clozapine may be clinically effective, the treatment may be stopped abruptly due to patient nonadherence, side effects (i.e., neutropenia/agranulocytosis), and/or medical complications (i.e., stroke, seizure, pulmonary embolism, etc.). Possible consequences of abrupt clozapine discontinuation include the rapid onset of an unusually severe psychotic relapse that is largely unresponsive to other treatments [ 7 ], the psychotic relapse following clozapine's rapid discontinuation can be prolonged [ 8 ], and/or the patient may not respond to clozapine when it is reintroduced in the future [ 9 ]. In some cases, clozapine discontinuation may result in delirium [ 10 ], severe anxiety, altered levels of consciousness, mental status changes, insomnia [ 11 ], somatic complaints including nausea, vomiting, diaphoresis, akathisia, motor restlessness, and dyskinetic movements, and excited catatonia and/or neuroleptic malignant syndrome (NMS) [ 12 ] that may cloud the clinical picture.…”