title: Safety and efficacy of combined clozapine-lithium pharmacotherapy.
abstract: Several case reports described neurotoxic side-effects in the course of a combined clozapine-lithium treatment. Here we report on the safety and efficacy of this combination in a sample of 44 hospital patients. Medical records were retrospectively audited and a subsample of 23 patients was re-assessed. Mean total duration of combined treatment was 23.5 months. The combination (indications: prophylaxis; treatment of affective symptoms or aggression/excitement; augmentation of neuroleptic efficacy) was rated effective in 84% and adverse events were reported in 64% of the patients. Notably, most of the adverse events were benign and transient. However, 8 patients (18%) developed transient neurological adverse events that were genuinely novel in only 3 patients (7%) and coincided with high dosage of medication or high plasma levels or serotonergic (antidepressant) co-medication. Our data suggest that combined clozapine-lithium treatment may appear to be safe and effective when administered within a moderate therapeutic dose range and without serotonergic co-medication or other substances interfering with clozapine metabolism.
authors.affiliation: Department of Psychiatry and Psychotherapy, The University of Duisburg-Essen, Essen, Germany. stefan.bender@uni-essen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Bender
authors.forename: Thomas
authors.initials: T
authors.lastname: Linka
authors.forename: Jörg
authors.initials: J
authors.lastname: Wolstein
authors.forename: Susanne
authors.initials: S
authors.lastname: Gehendges
authors.forename: Hermann-Josef
authors.initials: HJ
authors.lastname: Paulus
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schall
authors.forename: Markus
authors.initials: M
authors.lastname: Gastpar
mesh_terms: D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000503:physiopathology; D005260:Female; D006801:Humans; D008094:Lithium / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D008094:Lithium; D003024:Clozapine