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.