Clozapine Induced Hypertension and its Association with Autonomic Dysfunction.

Clozapine is a second generation antipsychotic agent which is drug of choice for treatment resistant schizophrenia. Tachycardia and postural hypotension are most frequently observed cardiovascular adverse effects, but reports on new-onset persistently elevated blood pressure are sparse. Mechanisms underlying clozapine induced hypertension also remain unclear. We report the case of a 32 year old normotensive male with persistently elevated systolic and diastolic blood pressure after clozapine initiation. Hypertension persisted throughout the phase of dose optimization and dose stabilization at 300 mg/day, requiring an addition of a beta blocker (atenolol) after a month of observation. The 24 hour urinary catecholamines were within normal limits. Autonomic function tests revealed severe loss of parasympathetic activity and cardiac autonomic tone. The case adds to limited information on autonomic dysfunction as a potential factor in clozapine induced hypertension.

Postinjection Delirium/Sedation Syndrome After 31st Long-Acting Olanzapine Depot Injection.

OBJECTIVE: Long-acting depot preparations of antipsychotics are the mainstay of treatment for patients with schizophrenia who show nonadherence to their medications. Olanzapine pamoate is one of the recently approved long-acting depot psychotropic preparations that have shown its efficacy both in clinical trials and in clinical uses against the illness. However, emerging literature indicates toward a cluster of adverse effects known as postinjection delirium/sedation syndrome (PDSS). METHODS: We here present a case of PDSS in a woman with paranoid schizophrenia. After maintaining well for almost 1½ years, she developed PDSS at her 31st scheduled long-acting olanzapine injection. RESULTS: Several features of PDSS including its mechanism and course have been discussed. CONCLUSIONS: More research is necessary to understand the syndrome and the association between PDSS and long-acting olanzapine injection. Clinicians should keep in mind that PDSS may worsen compliance in an index patient and affect the course of the illness.