Clozapine pancreatitis with

Sani G, Kotzalidis CD, Simonetti A, Solfanelli A, Mancinelli I, Calabro G, De Rossi P, De Luca O, Gentile G, Lionetto L, Manfredi G, Girardi N, Ambrosi E, Simmaco M, Tatarelli R. Development of asymptomatic pancreatitis with paradoxically high serum clozapine levels in a patient with schizophrenia and the CYP1A2 1F/1F genotype. J Clin Psychopharmacol 2010 30 737-9. 

A 73-year-old woman with a 4-year history of Parkinson s disease developed hallucinations and delusions that were interpreted as secondary effects of levodopa (187). She was given clozapine 25 mg/day and continued to take levodopa. Four days later she complained of abdominal pain. She had raised activities of serum amylase 806 IU/1 (reference range <220 IU/1), lipase 2598 IU/1 (<190 IU/1), and creatine kinase 464 IU/1 (<190 IU/1), and normal concentrations of total and direct bilirubin. Other causes of pancreatitis were ruled out. 

Two other cases have been reported in patients with no prior history of alcohol abuse or gallstones (189,190). The authors recommended monitoring serum amylase activity during slow increases in the dosage of clozapine if there is leukocytosis or eosinophilia, which may be associated with asymptomatic pancreatitis. 

Wehmeier PM, Heiser P, Remschmidt H. Pancreatitis followed by pericardial effusion in an adolescent treated with clozapine. J Clin Psychopharmacol 2003 23 102-3. 

Bergemann N, Ehrig C, Diebold K, Mundt C, von Einsiedel R. Asymptomatic pancreatitis associated with clozapine. Pharmacopsychiatry 1999 32(2) 78-80. 

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