Treatment of refractory hypotension with low-dose vasopressin in a patient receiving clozapine.

摘要

CLOZAPINE (Clozaril; Novartis Pharmaceuticals, Basel, Switzerland) is an atypical antipsychotic that is increasingly being used to treat refractory schizophrenia. It is classified as a tricyclic dibenzodiazepine derivative that was first introduced in Finland in 1975 and approved by the Food and Drug Administration for use in the United States in 1989. Clozapine exerts its influence by antagonizing a wide range of dopaminergic, serotonergic, cholinergic, histaminergic, and ad-renergic receptors. Despite an incidence of agranulocytosis of up to 2% when first introduced, clozapine's relative freedom from extrapyramidal side effects and improved symptom control has led to its resurgence when used in conjunction with close monitoring of white blood cell counts. More recently, it has been discovered that these agents also cause alpha-adrener-gic-receptor blockade, which can contribute to significant he-modynamic disturbances. A case of a patient receiving clozapine who experienced severe, intraoperative hypotension during general anesthesia, which was refractory to high-dose alpha-adrenergic agents, is presented.