Changes in Clozapine Bioavailability in a Percutaneous Endoscopic Gastrostomy-Fed Patient With Treatment-Resistant Schizophrenia

Kuzin, Maxim; Bochon, Benjamin; Vagiaris, Efstratios; Dammann, Gerhard; Gründer, Gerhard; Paulzen, Michael; Schoretsanitis, Georgios

doi:10.1097/jcp.0000000000001207

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…7,12 By contrast, the activity of CYP1A2 may decrease during inflammation due to SARS-CoV-2 infection, 12 leading to elevated levels of CYP1A2 substrates, such as clozapine. 13,14 The update of the "Consensus Guidelines for Therapeutic Drug Monitoring (TDM) in Neuropsychopharmacology" provides a therapeutic reference range for more than 100 drugs. 9 Downregulation and upregulation of CYP isoenzyme activity may lead to changes in the measured plasma levels and even affect the safety or outcome of psychopharmacological treatment.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study

Kuzin

Gardin

Götschi

et al. 2023

Therapeutic Drug Monitoring

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Background: Limited evidence from case reports suggests that coronavirus disease 2019 (COVID-19) vaccination may interact with the treatment outcomes of psychiatric medications. Apart from clozapine, reports on the effect of COVID-19 vaccination on other psychotropic agents are scarce. This study aimed to investigate the impact of COVID-19 vaccination on the plasma levels of different psychotropic drugs using therapeutic drug monitoring.Methods: Plasma levels of psychotropic agents, including agomelatine, amisulpride, amitriptyline, escitalopram, fluoxetine, lamotrigine, mirtazapine, olanzapine, quetiapine, sertraline, trazodone, and venlafaxine, from inpatients with a broad spectrum of psychiatric diseases receiving COVID-19 vaccinations were collected at 2 medical centers between 08/2021 and 02/2022 under steady-state conditions before and after vaccination. Postvaccination changes were estimated as a percentage of baseline.Results: Data from 16 patients who received COVID-19 vaccination were included. The largest changes in plasma levels were reported for quetiapine (+101.2%) and trazodone (238.5%) in 1 and 3 patients, respectively, 1 day postvaccination compared with baseline levels. One week postvaccination, the plasma levels of fluoxetine (active moiety) and escitalopram increased by 31% and 24.9%, respectively. Conclusions:This study provides the first evidence of major changes in the plasma levels of escitalopram, fluoxetine, trazodone, and quetiapine after COVID-19 vaccination. When planning COVID-19 vaccination for patients treated with these medications, clinicians should monitor rapid changes in bioavailability and consider short-term dose adjustments to ensure safety.

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Section: Introductionmentioning

confidence: 99%

“…7,12 By contrast, the activity of CYP1A2 may decrease during inflammation due to SARS-CoV-2 infection, 12 leading to elevated levels of CYP1A2 substrates, such as clozapine. 13,14…”

Section: Introductionmentioning

confidence: 99%

Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study

Kuzin

Gardin

Götschi

et al. 2023

Therapeutic Drug Monitoring

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Altered clozapine bioavailability in patient with feeding tube

Lam¹

2021

Psychopharmacology Update

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Clozapine is primarily used in patients with treatment‐refractory schizophrenia. Its pharmacokinetic profile reflects variable bioavailability, ranging from 27 to 70%, and complex metabolic pathways, with CYP1A2 as the primary drug‐metabolizing enzyme as well as additional involvement by others (CYP2C19, CYP2D6, and CYP3A4). In addition, enzymatic activity of CYP1A2 is increased by smoking, which is common in patients with schizophrenia.

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Alternative Routes of Administration of Clozapine

Gee

Taylor

2022

CNS Drugs

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Changes in Clozapine Bioavailability in a Percutaneous Endoscopic Gastrostomy-Fed Patient With Treatment-Resistant Schizophrenia

Cited by 4 publications

References 11 publications

Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study

Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study

Altered clozapine bioavailability in patient with feeding tube

Alternative Routes of Administration of Clozapine

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