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- Title
Co-medication with disulfiram markedly increased serum clozapine levels: Two case reports.
- Authors
Hahl-Häkkinen, Lydia; Rask, Susanna Maria; Solismaa, Anssi; Ruuhonen, Sanna; Leinonen, Esa
- Abstract
Background: Alcohol use disorder (AUD) is a significant co-morbidity in patients with schizophrenia. Clozapine offers some benefits in treating patients with refractory schizophrenia and AUD, but co-medicating with disulfiram is also common. Procedures: We report two cases where co-medicating with disulfiram led to a significant increase in clozapine serum levels. Findings: Clozapine serum levels decreased to one-third in Patient 1 when disulfiram was discontinued and started to increase again when disulfiram was reintroduced. Patient 2 developed toxic serum levels of clozapine during disulfiram treatment combined with heavy coffee drinking and symptoms reminiscent of neuroleptic malignant syndrome. Conclusions: Clozapine and disulfiram are both metabolized by cytochrome P450 CYP1A2 and clinically relevant interaction through this shared pathway is possible.
- Subjects
DISULFIRAM; ALCOHOLISM; CLOZAPINE; NEUROLEPTIC malignant syndrome; AMISULPRIDE; CYTOCHROME P-450; CAFFEINE
- Publication
Journal of Psychopharmacology, 2023, Vol 37, Issue 2, p229
- ISSN
0269-8811
- Publication type
Article
- DOI
10.1177/02698811221148611