Characterization and Clinical Management of Clozapine-Induced Fever

Lowe, Carolina Molina; Grube, Rebekah R. Arthur; Scates, Ann C

doi:10.1345/aph.1k126

Cited by 31 publications

(31 citation statements)

References 19 publications

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“…The drug has a spectrum of side effects (not discussed in this review), importantly including fever which is mentioned here 73. Clozapine-induced hyperpyrexia is a known common side effect following the use of this antipsychotic,74 usually being encountered within the first 4 weeks of treatment and has a prevalence that varies from 0.5% to 55% 75,76. It lasts for 2.5 days on average and if treatment is not discontinued then fever abates between 8 and 16 days 77.…”

Section: Clinical Features Of the Neuroleptic Syndromementioning

confidence: 99%

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Oruch¹,

Pryme²,

Engelsen³

et al. 2017

NDT

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Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment.

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Section: Clinical Features Of the Neuroleptic Syndromementioning

confidence: 99%

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Oruch¹,

Pryme²,

Engelsen³

et al. 2017

NDT

View full text Add to dashboard Cite

show abstract

“…If the fever characteristics are typical of a clozapine-induced fever and there are no further concerns, we advocate for continued cloza pine therapy. Numerous authors support this approach; [1][2][3][4]9 however, to our knowledge, this is the first detailed case report demonstrating the safety of this practice.…”

mentioning

confidence: 98%

“…[1][2][3][4][5] Typical clozapine fevers spike to less than 40°C, average 2.5 days, and occur within the first month of therapy.…”

mentioning

confidence: 99%

“…7 The etiology of clozapine-induced fevers in unknown, but theories include mild neuroleptic malignant syndrome, allergic reaction, infection that evaded detection and immune modulation. [1][2][3] Clozapine-induced fevers are documented as a benign side effect. 1,2,8 Tham and Dickson 2 examined the presence of clozapine-induced fever in 93 clozapine initiations and found no association between clozapineinduced fever and subsequent agranulocytosis or other adverse reactions within 1 year of initiating therapy.…”

mentioning

confidence: 99%

“…[1][2][3] Clozapine-induced fevers are documented as a benign side effect. 1,2,8 Tham and Dickson 2 examined the presence of clozapine-induced fever in 93 clozapine initiations and found no association between clozapineinduced fever and subsequent agranulocytosis or other adverse reactions within 1 year of initiating therapy. The presence of fever did not predict discontinuation of the therapy at 1 year.…”

mentioning

confidence: 99%

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