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70 Hours of Coma by Clozapine Intoxication
Srikanth Maryada Reddy, M.B.B.S., M.D.; Praveen Homdeorao Khairkar, M.D.; Ulhas Jajoo, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E22-E23. doi:10.1176/appi.neuropsych.12090221
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Dept. of Psychiatry (SMR, PHK)
Dept. of Internal Medicine (UJ)
Mahatma Gandhi Institute of Medical Sciences
Sevagram, Maharashtra, India

Correspondence: Dr. Reddy; e-mail: skanthreddy@gmail.com

Copyright © 2013 American Psychiatric Association

Extract

To the Editor: Clozapine has, over time, proved its mantel in management of treatment-refractory schizophrenia.1 However, despite its proven efficacy, a dangerous side-effect profile of clozapine has always been a matter of concern, which has limited its usage.2 Literature is relatively silent on antipsychotic overdose-induced coma. Only three studies have so-far documented later rare neuropsychiatric presentation, and all of them were from western countries. We present the first-ever report of clozapine intoxication leading to about 70 hours of coma in a young woman from India.

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References

McEvoy  JP;  Lieberman  JA;  Stroup  TS  et al: CATIE Investigators:  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; 163:600–610
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Asenjo Lobos  C;  Komossa  K;  Rummel-Kluge  C  et al:  Clozapine versus other atypical antipsychotics for schizophrenia.  Cochrane Database Syst Rev 2010; 11:CD006633
[PubMed]
 
Renwick  AC;  Renwick  AG;  Flanagan  RJ  et al:  Monitoring of clozapine and norclozapine plasma concentration time-curves in acute overdose.  J Toxicol Clin Toxicol 2000; 38:325–328
[CrossRef] | [PubMed]
 
Vetter  PH;  Proppe  DG:  Clozapine-induced coma.  J Nerv Ment Dis 1992; 180:58–59
[CrossRef] | [PubMed]
 
Broich  K;  Heinrich  S;  Marneros  A:  Acute clozapine overdose: plasma concentration and outcome.  Pharmacopsychiatry 1998; 31:149–151
[CrossRef] | [PubMed]
 
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70 hours of coma by clozapine intoxication. J Neuropsychiatry Clin Neurosci 2013;25(4):E22-3.