{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:18:23Z","timestamp":1792513103282,"version":"4.5.0"},"reference-count":10,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,9,11]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>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 \u03b2<jats:sub>2<\/jats:sub>-agonist activity in the presence of clozapine-induced \u03b1-blockade. Clinicians need to have greater awareness of this serious interaction and avoid the use of epinephrine in patients taking clozapine.<\/jats:p>","DOI":"10.1136\/bcr-2021-243363","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T13:10:11Z","timestamp":1635772211000},"page":"e243363","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Paradoxical refractory hypotension following adrenaline administration in a patient taking clozapine"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0676-0006","authenticated-orcid":false,"given":"Anand","family":"Alagappan","sequence":"first","affiliation":[{"name":"Department of Intensive Care and Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaleen","family":"Baruah","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair","family":"Cockburn","sequence":"additional","affiliation":[{"name":"Department of Adult Psychiatry, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Euan A","family":"Sandilands","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK"},{"name":"Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK"},{"name":"National Poisons Information Service (Edinburgh unit), Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,1]]},"reference":[{"key":"2025082709132493000_14.11.e243363.1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1192\/S0007125000296840","article-title":"General pharmacology of clozapine","volume":"160","author":"Coward","year":"1992","journal-title":"Br J Psychiatry"},{"key":"2025082709132493000_14.11.e243363.2","doi-asserted-by":"publisher","DOI":"10.1016\/0014-2999(84)90478-3"},{"key":"2025082709132493000_14.11.e243363.3","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1053\/j.jvca.2009.09.005","article-title":"Treatment of refractory hypotension with low-dose vasopressin in a patient receiving clozapine","volume":"24","author":"John","year":"2010","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025082709132493000_14.11.e243363.4","doi-asserted-by":"publisher","DOI":"10.1023\/A:1023228626309"},{"key":"2025082709132493000_14.11.e243363.5","unstructured":"Taylor DM , Barnes TRE , Young AH . Clozapine: management of common adverse effects. In: The Maudsley prescribing guidelines in psychiatry. 13 edn. Hoboken, NJ: Wiley, 2019: 175\u2013202."},{"key":"2025082709132493000_14.11.e243363.6","doi-asserted-by":"crossref","unstructured":"Buckley PF , Gaughran F . Treatment-refractory schizophrenia: A clinical conundrum.. In: Buckley PF , Gaughran F , eds. Treatment-Refractory schizophrenia: a clinical conundrum. London: Springer, 2014: 1\u2013230.","DOI":"10.1007\/978-3-642-45257-4"},{"key":"2025082709132493000_14.11.e243363.7","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v69n0509"},{"key":"2025082709132493000_14.11.e243363.8","article-title":"Vasopressor-Refractory shock from clozapine overdose treated with synthetic angiotensin II infusion","volume":"2","author":"Wieruszewski","year":"2020","journal-title":"Crit Care Explor"},{"key":"2025082709132493000_14.11.e243363.9","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s12028-015-0129-6","article-title":"Failure of induced hypertension for symptomatic vasospasm in the setting of clozapine therapy","volume":"23","author":"Leung","year":"2015","journal-title":"Neurocrit Care"},{"key":"2025082709132493000_14.11.e243363.10","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243363","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:13:34Z","timestamp":1756311214000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":10,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,1]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/bcr-2021-243363"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243363","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}