Abstract
IntroductionGiven the limited range of effective drug treatments for patients with schizophrenia, increasing numbers of patients, often termed 'treatment-resistant' are prescribed clozapine. While the induction of neutropenia or agranulocytosis by clozapine is well appreciated, other rare potentially fatal adverse reactions may also occur including acute interstitial nephritis as reported in this case.Case presentationA 57-year-old Caucasian woman with treatment-resistant chronic schizophrenia developed acute renal failure following initiation of treatment with clozapine. The adverse reaction occurred after only four doses of the drug had been administered (titrated from 12.5 to 25 mg per day). After clozapine had been withdrawn, the patient's renal function returned to normal with no other changes to medication. The patient had been exposed to clozapine about 4 years previously when she had developed a similar reaction.ConclusionRenal reactions to clozapine are extremely rare but, if not recognized promptly, may prove fatal. Psychiatrists need to be aware of this possible complication when clozapine is initiated.
Highlights
Given the limited range of effective drug treatments for patients with schizophrenia, increasing numbers of patients, often termed ‘treatment-resistant’ are prescribed clozapine
We report a case of acute renal failure, assumed to be due to interstitial nephritis that developed in a 57-year-old Caucasian woman with treatment-resistant chronic schizophrenia following initiation of treatment with clozapine
As far as the authors are aware, there are no reports of acute interstitial nephritis caused by other atypical antipsychotics there are reports of acute renal failure occurring as a consequence of neuroleptic malignant syndrome
Summary
The dibenzodiazepine derivative, clozapine, is a so-called ‘atypical’ or second-generation antipsychotic that is widely regarded as one of the more effective drug treatments for schizophrenia It can cause serious adverse effects on the blood, including a potentially fatal neutropenia (around 2.7% of patients treated with clozapine), and its use is usually limited to treatment-resistant cases of schizophrenia. Case presentation The adverse reaction to clozapine occurred in a 57-year-old married Caucasian woman with a long history of treatment-resistant chronic schizophrenia (ICD10 F20) who has required continuing care in hospital for many years, due to the severity of her condition. She first developed schizophrenia at around the age of 18 and has received antipsychotic medication for almost 40 years. Renal function returned to normal over the few days
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