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

Abstract

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 β2-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.

• Authors: Anand Alagappan, Rosaleen Baruah, Alastair Cockburn, Euan A Sandilands
• Journal: BMJ case reports (BMJ Case Rep) Vol. 14 Issue 11 (Nov 01 2021) ISSN: 1757-790X [Electronic] England
• PMID: 34725057 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antipsychotic Agents
• Clozapine
• Epinephrine

Topics

• Antipsychotic Agents (adverse effects)
• Clozapine (adverse effects)
• Epinephrine (therapeutic use)
• Humans
• Hypotension (chemically induced)
• Male
• Schizophrenia (drug therapy)