Clozapine hypertension with

Metabolism A prospective, naturalistic study of 809 patients that compared 10 antipsychotics found there were no significant relationships between any of the antipsychotic drugs and increased waist circumference, HOMA-IR or LDL-cholesterol levels [54 ]. Hypertriglyceridemia was associated with clozapine, reduced HDL-cholesterol with both clozapine and olanzapine, hypertension with perphenazine, and hyperglycaemia inversely with ziprasidone and positively with haloperidol. 

As well as their effects on the brain, neuroleptics commonly produce other potentially lethal effects. They are all toxic to the heart, inducing conduction defects and arrhythmias. Olanzapine and clozapine also interfere with normal metabolism, causing what is known as metabolic syndrome. This syndrome has only recently been described and is defined as the occurrence of obesity, diabetes, hypertension and dyslipidaemia6 (Shirzadi Ghaemi 2006). The underlying cause of the syndrome is thought to be resistance to insulin. All these effects... 

Several cases of hypertension have been associated with clozapine (SEDA-22, 57), and alpha2-adrenoceptor blockade has been proposed as a possible mechanism (28). Four patients developed pseudopheochromocytoma syndrome associated with clozapine (33) all had hypertension, profuse sweating, and obesity. The authors suggested that clozapine could increase plasma noradrenaline concentrations by inhibiting prcsynaptic reuptake mediated by alpha2-adrenoceptors. 

A 22-year-old man developed atypical neuroleptic malignant syndrome while taking clozapine (104). He vomited and was sweating and agitated but afebrile, with mild hypertension (maximum 156/96 mmHg) and a tachycardia, with marked increases in white blood cell count (32 x 109/1), neutrophils (25 x 109/1), and creatine kinase (1442 IU/1) a similar syndrome occurred while he was taking haloperidol. 

A 39-year-old man with schizophrenia and diabetes, who had taken clozapine 300 mg/day and glipizide 10 mg/day for a year, took lisinopril 5 mg/day for newly diagnosed hypertension. On several occasions afterwards he had roughly a doubling of his blood concentrations of clozapine and norclozapine. He had typical effects of clozapine toxicity. After replacement of lisinopril by diltiazem, the blood concentrations of clozapine and norclozapine returned to the values that were present before lisinopril was introduced. 

A 39-year-old man with schizophrema and diabetes, who had taken clozapine 300 mg/day and glipizide 10 mg/day for a year, took lisinopril 5 mg/day for newly diagnosed hypertension. On several occasions... 

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