Clozapine intoxication in a patient with lamotrigine-induced rash.

摘要

Clozapine and lamotrigine are an effective combination in the therapy for treatment-resistant bipolar disorder [2]. These compounds are metabolized via different emzymatic pathways and their coadministration is thought to be free of relevant pharma-cokinetic interactions. There was one case report published showing an elevated clozapine plasma level with lamotrigine co-medication [5]. However, both compounds are associated with severe side effects: clozapine is known to have an increased risk of agranulocytosis compared to other atypical antipsychotics and lamotrigine may cause severe skin rash and life-threatening Stevens-Johnson syndrome. We report the case of a 43-year-old male patient with extremely elevated clozapine plasma levels, clinical signs of a clozapine intoxication and a severe drug-induced skin rash while on a combination of clozapine and lamotrigine. This case was assessed within the AMSP study for the assessment of severe adverse drug reactions [3]