Skip to main content
Top
Published in: International Journal of Clinical Pharmacy 6/2015

01-12-2015 | Case Report

Eosinophilia and parotitis occurring early in clozapine treatment

Authors: Bochra Nourhène Saguem, Saoussen Bouhlel, Chaker Ben Salem, Bechir Ben Hadj Ali

Published in: International Journal of Clinical Pharmacy | Issue 6/2015

Login to get access

Abstract

Case presentation

Mr. S is a 32-year-old male with schizophrenia. Due to poor responses to various antipsychotic medications, he was started on clozapine with the dose titrated to 300 mg/day during a 4-week period. The weekly checks of the complete blood cell count showed gradual increases in the eosinophil count from normal values to 4320 per mm3. Mr. S did not have any symptoms except some increased salivation. Clozapine was suspended, and eosinophils gradually began to decline to the normal range. Clozapine was subsequently re-started and there were no changes in eosinophil counts. Mr. S exhibited improvement of symptoms but complained of acute auricular pain and increased salivation, 8 weeks after clozapine rechallenge. He also developed a swelling of his both parotid glands. The diagnosis of clozapine-induced parotitis was suggested. Symptomatic medication was prescribed with a favorable outcome.

Conclusion

We report a case of a patient who developed eosinophilia shortly after clozapine use, and then developed parotitis. There is debate in the literature over how to manage these complications of clozapine treatment. Generally they do not warrant clozapine discontinuation.

Literature
  1. Wenthur CJ, Lindsley CW. Classics in chemical neuroscience: clozapine. ACS Chem Neurosci. 2013;4(7):1018–25.PubMed CentralView ArticlePubMed
  2. Meltzer HY. Update on typical and atypical antipsychotic drugs. Annu Rev Med. 2013;64:393–406.View ArticlePubMed
  3. Bailey P. Clozapine treatment, eosinophilia and agranulocytosis. Br J Psychiatry. 1997;171:90.View ArticlePubMed
  4. Kontoangelos K, Loizos S, Kanakakis J, Smyrnis N, Economou M, Bergiannaki JD, et al. Myocarditis after administration of clozapine. Eur Rev Med Pharmacol Sci. 2014;18(16):2383–6.PubMed
  5. Brooks KG, Thompson DF. A review and assessment of drug-induced parotitis. Ann Pharmacother. 2012;46(12):1688–99.View ArticlePubMed
  6. Frankenburg FR, Kando J. Eosinophilia, clozapine, and pancreatitis. Lancet. 1992;340(8813):251.View ArticlePubMed
  7. Fong SY, Au Yeung KL, Tosh JM, Wing YK. Clozapine-induced toxic hepatitis with skin rash. J Psychopharmacol. 2005;19(1):107.View ArticlePubMed
  8. Karmacharya R, Mino M, Pirl WF. Clozapine-induced eosinophilic colitis. Am J Psychiatry. 2005;162(7):1386–7.View ArticlePubMed
  9. Base de données publique des médicaments. (2015). Leponex 100 mg, [en ligne]. http://​base-donnees-publique.​medicaments.​gouv.​fr/​affichageDoc.​php?​specid=​62552920&​typedoc=​R.
  10. Roberts CE, Mortenson LY, Merrill DB, Rafizadeh N, Smith TE, Lieberman JA. Successful rechallenge with clozapine after eosinophilia. Am J Psychiatry. 2011;168(11):1147–51.View ArticlePubMed
  11. Schuepbach D, Merlo MC, Kaeser L, Brenner HD. Successful challenge with clozapine in a history of eosinophilia. Int Clin Psychopharmacol. 1998;13(1):33–7.View ArticlePubMed
  12. Floreani J, Bastiampillai T. Successful re-challenge with clozapine following development of clozapine-induced cardiomyopathy. Aust N Z J Psychiatry. 2008;42(8):747–8.PubMed
  13. Himmerich H, Schönherr J, Fulda S, Sheldrick AJ, Bauer K, Sack U. Impact of antipsychotics on cytokine production in-vitro. J Psychiatr Res. 2011;45(10):1358–65.View ArticlePubMed
  14. Lucht MJ, Rietschel M. Clozapine-induced eosinophilia: subsequent neutropenia and corresponding allergic mechanisms. J Clin Psychiatry. 1998;59(4):195–7.View ArticlePubMed
  15. Roge R, Moller BK, Andersen CR, Correll CU, Nielsen J. Immunomodulatory effects of clozapine and their clinical implications: what have we learned so far? Schizophr Res. 2012;140(1–3):204–13.View ArticlePubMed
  16. Simon D, Simon HU. Eosinophilic disorders. J Allergy Clin Immunol. 2007;119(6):1291–300.View ArticlePubMed
  17. Sperner-Unterweger B, Gaggl S, Fleischhacker WW, Barnas C, Herold M, Geissler D. Effects of clozapine on hematopoiesis and the cytokine system. Biol Psychiatry. 1993;34(8):536–43.View ArticlePubMed
  18. Martin SD. Drug-induced parotid swelling. Br J Hosp Med. 1993;50(7):426.PubMed
  19. Hinze-Selch D, Becker EW, Stein G, Schreiber W, Pollmächer T. Clozapine-induced parotitis: an immunological cause? Am J Psychiatry. 1996;153(6):840.PubMed
  20. Robinson D, Fenn H, Yesavage J. Possible association of parotitis with clozapine. Am J Psychiatry. 1995;152(2):297–8.View ArticlePubMed
  21. Vasile JS, Steingard S. Clozapine and the development of salivary gland swelling: a case study. J Clin Psychiatry. 1995;56(11):511–3.PubMed
  22. Davé M. Iatrogenic salivary gland swelling. J Pharm Technol. 1995;11:18–20.
  23. Brodkin ES, Pelton GH, Price LH. Treatment of clozapine-induced parotid gland swelling. Am J Psychiatry. 1996;153(3):445.PubMed
  24. Patkar AA, Alexander RC. Parotid gland swelling with clozapine. J Clin Psychiatry. 1996;57(10):488.View ArticlePubMed
  25. Southhall K, Fernando N. Report of a rare medical complication on clozapine. Aust NZ J Psychiat. 1999;33:122–3.View Article
  26. McKay D. Perhaps not so rare? Aust NZ J Psychiat. 2000;34(2):340–1.
  27. Gouzien C, Valiamé A, Misdrahi D. Clozapine-induced parotitis: a case study. L’encéphale. 2014;40:81–5.View ArticlePubMed
  28. Praharaj SK, Arora M, Gandotra S. Clozapine-induced sialorrhea: pathophysiology and management strategies. Psychopharmacology. 2006;185(3):265–73.View ArticlePubMed
  29. Bai YM, Lin CC, Chen JY, Liu WC. Therapeutic effect of pirenzepine for clozapine-induced hypersalivation: a randomized, double-blind, placebo-controlled, cross-over study. J Clin Psychopharmacol. 2001;21(6):608–11.View ArticlePubMed
Metadata
Title
Eosinophilia and parotitis occurring early in clozapine treatment
Authors
Bochra Nourhène Saguem
Saoussen Bouhlel
Chaker Ben Salem
Bechir Ben Hadj Ali
Publication date
01-12-2015
Publisher
Springer Netherlands
Published in
International Journal of Clinical Pharmacy / Issue 6/2015
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-015-0163-7

Other articles of this Issue 6/2015

International Journal of Clinical Pharmacy 6/2015 Go to the issue