Management of marked liver enzyme increase during clozapine treatment: a case report and review of the literature.
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of the clozapine treatment was successfully managed with a multidisciplinary approach: the treatment was initially withdrawn, afterwards restarted, and carefully continued.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.
Erdogan
Ayten
A
Istanbul University, Cerrahpasa Tip Fakultesi, Psikiyatri Anabilim Dali, Turkey. aytenerd@yahoo.com
Kocabasoglu
Nese
N
Yalug
Irem
I
Ozbay
Gulsen
G
Senturk
Hakan
H
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
D014150:Antipsychotic Agents; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D003024:Clozapine