Hemoperfusion in the treatment of acute clozapine intoxication in China.
OBJECTIVE
No systematic study has focused on the characteristics and outcome of acute clozapine intoxication, although clozapine is the most widely used antipsychotic agent in China. The study reported herein examined the features of clozapine intoxication and the therapeutic effect of hemoperfusion (HP).


METHODS
In a retrospective chart review, the notes of 47 patients who attempted suicide by ingesting large amounts of clozapine and were treated at the only psychiatric emergency service in Beijing were analyzed. Of the 20 unconscious patients with plasma clozapine concentrations of more than 2000 ng/mL, 14 received a combination of HP and symptomatic treatment, whereas the other 6 and the remaining 27 patients received only symptomatic treatment. Patients' psychiatric conditions and both plasma clozapine and norclozapine concentrations were closely monitored and registered.


RESULTS
One patient died of pulmonary edema and subsequent heart failure, but the rest of the patients recovered without any sequelae. Patients who received HP regained consciousness significantly faster than their counterparts with the same level of clozapine plasma concentration (>2000 ng/mL) who did not receive HP.


CONCLUSIONS
A combination of HP and symptomatic treatment is the best therapeutic option when plasma clozapine concentration is high.
He
Jia-Li
JL
Beijing Anding Hospital, Capital Medical University, Beijing, China.
Xiang
Yu-Tao
YT
Li
Wen-Biao
WB
Cai
Zhuo-Ji
ZJ
Ungvari
Gabor Sandor
GS
D000208:Acute Disease; D000328:Adult; D000525:Alprazolam / Q000506:poisoning / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000506:poisoning / Q000627:therapeutic use; D002681:China; D002998:Clonazepam / Q000506:poisoning / Q000627:therapeutic use; D003024:Clozapine / Q000506:poisoning* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006464:Hemoperfusion / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D011654:Pulmonary Edema / Q000139:chemically induced; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013469:Sulpiride / Q000506:poisoning / Q000627:therapeutic use; D014474:Unconsciousness / Q000139:chemically induced; D014920:Wine / Q000009:adverse effects
D014150:Antipsychotic Agents; D002998:Clonazepam; D013469:Sulpiride; D003024:Clozapine; D000525:Alprazolam