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Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Case report

Burning pain secondary to clozapine use: a case report

Authors: Bradley Linton, Rachel Fu, Penny A MacDonald, Hooman Ganjavi

Published in: BMC Psychiatry | Issue 1/2014

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Abstract

Background

The first of the atypical antipsychotics introduced in the 1970s, clozapine remains the most efficacious neuroleptic to this day. However, serious and potentially fatal side effects have necessitated careful regular monitoring among prescribing clinicians. Some adverse effects (e.g. ischaemic bowel) remain under recognized, while newly identified adverse effects continue to be described in the literature.

Case presentation

In this report, we describe a healthy 43-year old Caucasian male who experienced onset of a full body deep burning pain several months after the onset of treatment with clozapine. The pain worsened over time, ceased with cessation of treatment, and returned soon after the patient was rechallenged.

Conclusion

We describe an unusual adverse effect from clozapine treatment that has not been described elsewhere to our knowledge. We present the time course of the pain symptom, relationship to dose, associated laboratory results, and ultimately how it was dealt with and how it improved for the benefit of clinicians who may encounter it in the future.
Literature
1.
go back to reference McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, Swartz MS, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK: Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006, 163 (4): 600-610. 10.1176/appi.ajp.163.4.600.CrossRefPubMed McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, Swartz MS, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK: Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006, 163 (4): 600-610. 10.1176/appi.ajp.163.4.600.CrossRefPubMed
2.
go back to reference Essali A, Al-Haj Haasan N, Li C, Rathbone J: Clozapine versus typical neuroleptic medication for schizophrenia.The Cochrane Database of Systematic Reviews 2009, (1):CD000059., Essali A, Al-Haj Haasan N, Li C, Rathbone J: Clozapine versus typical neuroleptic medication for schizophrenia.The Cochrane Database of Systematic Reviews 2009, (1):CD000059.,
3.
go back to reference Lewis SW, Barnes TR, Davies L, Murray RM, Dunn G, Hayhurst KP, Markwick A, Lloyd H, Jones PB: Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull. 2006, 32 (4): 715-723. 10.1093/schbul/sbj067.CrossRefPubMedPubMedCentral Lewis SW, Barnes TR, Davies L, Murray RM, Dunn G, Hayhurst KP, Markwick A, Lloyd H, Jones PB: Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull. 2006, 32 (4): 715-723. 10.1093/schbul/sbj067.CrossRefPubMedPubMedCentral
4.
go back to reference Manu P, Sarpal D, Muir O, Kane JM, Correll CU: When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature. Schizophr Res. 2012, 134 (2-3): 180-186. 10.1016/j.schres.2011.10.014.CrossRefPubMed Manu P, Sarpal D, Muir O, Kane JM, Correll CU: When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature. Schizophr Res. 2012, 134 (2-3): 180-186. 10.1016/j.schres.2011.10.014.CrossRefPubMed
5.
go back to reference Merrill DB, Dec GW, Goff DC: Adverse cardiac effects associated with clozapine. J Clin Psychopharmacol. 2005, 25 (1): 32-41. 10.1097/01.jcp.0000150217.51433.9f.CrossRefPubMed Merrill DB, Dec GW, Goff DC: Adverse cardiac effects associated with clozapine. J Clin Psychopharmacol. 2005, 25 (1): 32-41. 10.1097/01.jcp.0000150217.51433.9f.CrossRefPubMed
6.
go back to reference Pelizza L, Melegari M: Clozapine-induced microscopic colitis: a case report and review of the literature. J Clin Psychopharmacol. 2007, 27 (6): 571-574. 10.1097/jcp.0b013e31815a257f.CrossRefPubMed Pelizza L, Melegari M: Clozapine-induced microscopic colitis: a case report and review of the literature. J Clin Psychopharmacol. 2007, 27 (6): 571-574. 10.1097/jcp.0b013e31815a257f.CrossRefPubMed
7.
go back to reference Mouaffak F, Gaillard R, Burgess E, Zaki H, Olie JP, Krebs MO: Clozapine-induced serositis: review of its clinical features, pathophysiology and management strategies. Clin Neuropharmacol. 2009, 32 (4): 219-223. 10.1097/WNF.0b013e318197a2f2.CrossRefPubMed Mouaffak F, Gaillard R, Burgess E, Zaki H, Olie JP, Krebs MO: Clozapine-induced serositis: review of its clinical features, pathophysiology and management strategies. Clin Neuropharmacol. 2009, 32 (4): 219-223. 10.1097/WNF.0b013e318197a2f2.CrossRefPubMed
8.
go back to reference APA: Drug Information for Mental Health. Lexi-Comp’s Clinical Reference Library. 2001, Lexi-Comp; American Pharmaceutical Association, Hudson, Ohio and Washington, D.C, APA: Drug Information for Mental Health. Lexi-Comp’s Clinical Reference Library. 2001, Lexi-Comp; American Pharmaceutical Association, Hudson, Ohio and Washington, D.C,
9.
go back to reference Raaska K, Raitasuo V, Arstila M, Neuvonen PJ: Bacterial pneumonia can increase serum concentration of clozapine. Eur J Clin Pharmacol. 2002, 58 (5): 321-322. 10.1007/s00228-002-0486-x.CrossRefPubMed Raaska K, Raitasuo V, Arstila M, Neuvonen PJ: Bacterial pneumonia can increase serum concentration of clozapine. Eur J Clin Pharmacol. 2002, 58 (5): 321-322. 10.1007/s00228-002-0486-x.CrossRefPubMed
10.
go back to reference de Leon J, Diaz FJ: Serious respiratory infections can increase clozapine levels and contribute to side effects: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2003, 27 (6): 1059-1063. 10.1016/S0278-5846(03)00148-9.CrossRefPubMed de Leon J, Diaz FJ: Serious respiratory infections can increase clozapine levels and contribute to side effects: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2003, 27 (6): 1059-1063. 10.1016/S0278-5846(03)00148-9.CrossRefPubMed
11.
go back to reference Haack MJ, Bak ML, Beurskens R, Maes M, Stolk LM, Delespaul PA: Toxic rise of clozapine plasma concentrations in relation to inflammation. Eur Neuropsychopharmacol. 2003, 13 (5): 381-385. 10.1016/S0924-977X(03)00042-7.CrossRefPubMed Haack MJ, Bak ML, Beurskens R, Maes M, Stolk LM, Delespaul PA: Toxic rise of clozapine plasma concentrations in relation to inflammation. Eur Neuropsychopharmacol. 2003, 13 (5): 381-385. 10.1016/S0924-977X(03)00042-7.CrossRefPubMed
12.
go back to reference Jecel J, Michel TM, Gutknecht L, Schmidt D, Pfuhlmann B, Jabs BE: Toxic clozapine serum levels during acute urinary tract infection: a case report. Eur J Clin Pharmacol. 2005, 60 (12): 909-910. 10.1007/s00228-004-0867-4.CrossRefPubMed Jecel J, Michel TM, Gutknecht L, Schmidt D, Pfuhlmann B, Jabs BE: Toxic clozapine serum levels during acute urinary tract infection: a case report. Eur J Clin Pharmacol. 2005, 60 (12): 909-910. 10.1007/s00228-004-0867-4.CrossRefPubMed
Metadata
Title
Burning pain secondary to clozapine use: a case report
Authors
Bradley Linton
Rachel Fu
Penny A MacDonald
Hooman Ganjavi
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0299-3

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