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MASSIVE CLOZAPINE OVERDOSE: WHAT TO EXPECT?

Clozapine is an atypical antipsychotic drug indicated for treatment-resistant schizophrenia. Despite its superior clinical efficacy, many deleterious adverse events, including agranulocytosis, have resulted in its more judicious use (Asenjo Lobos et al. 2010). The most frequently reported symptoms of clozapine intoxication are impaired alertness and tachycardia ; other symptoms include: hyperthermia, alterations in consciousness, dysarthria, ataxia, seizures, cardiac arrhythmias, excessive bronchial mucus, hypersalivation, miosis, blood dyscrasias, pancreatitis and hepatitis (Le Blaye et al. 1992, Krämer et al. 2010). Studies that evaluated the case fatality rate with various antipsychotics concluded that clozapine was far more toxic than other antipsychotics (Ferrey 2018). To the best of our knowledge, this is the fist case report describing treatment and outcomes following a massive overdose of clozapine, amounting to 46.7 times the recommended patient’s daily dose of clozapine

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