title: Management of marked liver enzyme increase during clozapine treatment: a case report and review of the literature.
abstract: OBJECTIVE
  Clozapine-induced hepatotoxicity is not infrequent and usually transient. It mostly causes asymptomatic elevation of liver transaminases. "Elevation in liver enzymes to what extent should preclude further treatment?" or "Is only a dose-reduction sufficient?" are questions yet to be answered. The present article uses a case report to discuss the treatment alternatives when liver enzymes reach three times the upper normal limits during the clozapine therapy.
  
  
  METHODS
  In the following case report, the authors describe a 27-year-old male patient diagnosed with schizophrenia, resistant to different atypical and typical antipsychotics. Based on the pathological findings of our patient and a review of the literature, the author summarizes the reasons for the liver enzymes increase and treatment alternatives during clozapine treatment.
  
  
  RESULTS
  Substantial improvement was achieved with clozapine therapy. Increase in liver enzymes at the beginning of the clozapine treatment was successfully managed with a multidisciplinary approach: the treatment was initially withdrawn, afterwards restarted, and carefully continued.
  
  
  CONCLUSIONS
  The authors demonstrate that clozapine may be cautiously continued in selected patients who showed marked psychiatric improvement with clozapine in the face of liver enzyme elevation.
authors.affiliation: Istanbul University, Cerrahpasa Tip Fakultesi, Psikiyatri Anabilim Dali, Turkey. aytenerd@yahoo.com
authors.forename: Ayten
authors.initials: A
authors.lastname: Erdogan
authors.forename: Nese
authors.initials: N
authors.lastname: Kocabasoglu
authors.forename: Irem
authors.initials: I
authors.lastname: Yalug
authors.forename: Gulsen
authors.initials: G
authors.lastname: Ozbay
authors.forename: Hakan
authors.initials: H
authors.lastname: Senturk
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003024:Clozapine / Q000008:administration & dosage / Q000009:adverse effects*; D016903:Drug Monitoring; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy* / Q000201:enzymology; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D014150:Antipsychotic Agents; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D003024:Clozapine