Clozapine, drug interactions

Eerslew KE, Hagardom AN, Harlan GC, McCormick WE. 1998. A fatal drug interaction between clozapine and fluoxetine. J Forensic Sci 43 1082. 

Drug interactions Diuretics" NSAIDs (e.g., ibuprofen)" Lamotrigine Clozapine" Contraceptives HIV protease inhibitors" ... 

Another practical example of a pharmacokinetic drug interaction concerns the incidence of seizures in patients given a standard (300 mg/ day) dose of clozapine. Should the patient be given an SSRI antidepressant (such as fluoxetine, fluvoxamine, sertraline or paroxetine) concurrently then the clearance of clozapine could be reduced by up to 50%, an effect which would be comparable with a doubling of the dose. This could lead to a threefold increase in the risk of the patient suffering a seizure. 

Hypersensitivity to the drug or any other component of the product (cross-sensitivity between phenothiazines may occur) comatose or greatly depressed states caused by CNS depressants or from any other cause (phenothiazines, clozapine, loxapine, molindone, pimozide, haloperidol) coadministration with other drugs that prolong the QT interval and in patients with congenital long QT syndrome or history of cardiac arrhythmias (mesoridazine, thioridazine, pimozide, ziprasidone see Drug..Interactions). 

Borba CP, Henderson DC. Citalopram and clozapine potential drug interaction. J Clin Psychiatry 2000 61(4) 301-2. 

Chang WH, Augustin B, Lane HY, ZumBrunnen T, Liu HC, Kazmi Y, Jann MW. In-vitro and in-vivo evaluation of the drug-drug interaction between fluvoxamine and clozapine. Psychopharmacology (Berl) 1999 145(l) 91-8. 

Edge SC, Markowitz JS, DeVane CL. Clozapine drug-drug interactions a review of the literature. Hum Psychopharmacol 1997 12 5-20. 

Lane HY, Chiu CC, Kazmi Y, Desai H, Lam YW, Jann MW, Chang WH. Lack of CYP3A4 inhibition by grapefruit juice and ketoconazole upon clozapine administration in vivo. Drug Metabol Drug Interact 2001 18(3— 4) 263—78. 

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