Paradoxical refractory hypotension following adrenaline administration in a patient taking clozapine.

Autor: Alagappan A; Department of Intensive Care and Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK., Baruah R; Department of Intensive Care and Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK., Cockburn A; Department of Adult Psychiatry, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK., Sandilands EA; Department of Acute Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK euan.sandilands@nhslothian.scot.nhs.uk.; Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK.; National Poisons Information Service (Edinburgh unit), Edinburgh, UK.
Jazyk: angličtina
Zdroj: BMJ case reports [BMJ Case Rep] 2021 Nov 01; Vol. 14 (11). Date of Electronic Publication: 2021 Nov 01.
DOI: 10.1136/bcr-2021-243363
Abstrakt: Clozapine is a potent antipsychotic commonly used for refractory schizophrenia. Adverse effects are well recognised including constipation, intestinal obstruction, agranulocytosis and cardiomyopathy. We present a case of paradoxical refractory hypotension following epinephrine administration in a patient taking clozapine. A psychiatric inpatient who had been taking clozapine for many years developed paralytic ileus and obstruction requiring surgical intervention. Following initiation of epinephrine administration intraoperatively he developed refractory hypotension which improved only when epinephrine was weaned off. This effect is likely due to uninterrupted β 2 -agonist activity in the presence of clozapine-induced α-blockade. Clinicians need to have greater awareness of this serious interaction and avoid the use of epinephrine in patients taking clozapine.
Competing Interests: Competing interests: None declared.
(© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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