title: Failure of Induced Hypertension for Symptomatic Vasospasm in the Setting of Clozapine Therapy.
abstract: BACKGROUND
  Hemodynamic augmentation is utilized as a treatment in the setting of symptomatic cerebral vasospasm. This approach includes the use of vasopressors to induce hypertension with the aim of improved cerebral blood flow. Agents with potent alpha-1 antagonism properties, including clozapine, can inhibit or blunt the response of several vasopressor agents.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 54-year-old schizophrenic male with an aneurysmal subarachnoid hemorrhage required hemodynamic augmentation in which several vasopressor trials resulted in no or poor response. The addition of epinephrine resulted in a decrease of mean arterial pressure. Vasopressin initiation demonstrated an immediate vasopressor effect.
  
  
  CONCLUSIONS
  Vasopressors are an important treatment modality in symptomatic cerebral vasospasm. This case highlights the potential for clozapine to blunt the effects of vasopressors; or in the case of epinephrine, it causes a reversal effect. Vasopressin may be considered an agent of choice in patients who have recently taken clozapine and require hemodynamic augmentation.
authors: Department of Pharmacy, Mayo Clinic, 1216 2nd Street SW, Rochester, MN, 55902, USA. Leung.jonathan@mayo.edu.
authors: Jonathan G
authors: JG
authors: Leung
authors: Department of Pharmacy, Mayo Clinic, 1216 2nd Street SW, Rochester, MN, 55902, USA.
authors: Sarah
authors: S
authors: Nelson
authors: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors: Sara
authors: S
authors: Hocker
mesh_terms: D003024:Clozapine / Q000494:pharmacology*; D004347:Drug Interactions; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D018756:GABA Antagonists / Q000494:pharmacology*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology*; D014667:Vasopressins / Q000008:administration & dosage / Q000494:pharmacology*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
chemical_list: D018756:GABA Antagonists; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D003024:Clozapine; D004837:Epinephrine
keywords: Cerebral vasospasm; Clozapine; Dobutamine; Epinephrine; Hemodynamic augmentation; Norepinephrine; Vasopressin