Korean J Psychosom Med.  2022 Dec;30(2):66-72. 10.22722/KJPM.2022.30.2.66.

A Review on the Cause of Fever During Clozapine Treatment

• Song J
• Je S
• Lee J
• Lee S
• Lee SH
• Lee E
• So H
• Choi H
• Choi J

• KMID: 2538668
• DOI: http://doi.org/10.22722/KJPM.2022.30.2.66

Abstract

Clozapine is accepted as the “gold standard” antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.

Keyword

Clozapine; Fever; Adverse drug reactions; Differential diagnosis; Discontinue