{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:47:12Z","timestamp":1787960832164,"version":"build-2784847793"},"reference-count":25,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2018,1,2]],"date-time":"2018-01-02T00:00:00Z","timestamp":1514851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Psychiatry Med"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Serious infections or inflammations have been associated with serum clozapine concentration increases and sometimes with clozapine toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>These two cases describe Chinese patients (Case 1: a 57-year-old female nonsmoker with severe dermatitis and Case 2: a 47-year-old male nonsmoker with influenza and secondary infection).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In both cases, the Drug Interaction Probability Scale established the presence of a probable drug\u2013drug interaction. In both cases, the clozapine and the total clozapine concentration-to-dose ratios followed a temporal pattern (normal\u2013high\u2013normal), consistent with an inhibition of clozapine metabolism during peak inflammation. In the first case, the total clozapine concentration-to-dose ratio (8 with no\/low inflammation: median of 3.10 and 2 at peak inflammation: median of 3.90) provided a significant difference (P\u2009=\u20090.044). In the second patient, because of the smaller sample size and reduced statistical power (4 with no infection: a median of 1.59 and 2 at peak infection: 3.46), the increase did not reach significance (P\u2009=\u20090.13). In the first case, the median baseline clozapine concentration-to-dose ratio increased by a factor of 1.45 from 2.00 to a peak of 2.89. To compensate for the inhibition of clozapine metabolism, the dose correction factor was 0.69 (1\/1.45) or a decrease in dose of approximately one-third. In the second case, the median baseline clozapine concentration-to-dose ratio increased by a factor of 2.56 from 1.15 to a peak of 2.94.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This provided a dose correction factor of 0.40 (1\/2.56) or approximately half the dose, similar to published cases in Caucasians with serious respiratory infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0091217417749799","type":"journal-article","created":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T14:56:02Z","timestamp":1515077762000},"page":"292-305","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":24,"title":["Two cases of high serum clozapine concentrations occurring during inflammation in Chinese patients"],"prefix":"10.1177","volume":"53","author":[{"given":"Can-Jun","family":"Ruan","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Psychopharmacology & The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Ling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy & The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Biao","family":"Li","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Psychopharmacology & The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Yan","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy & The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Qiong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Atlanta VA Medical Center, The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan-Yue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Atlanta VA Medical Center, The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Lang","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Atlanta VA Medical Center, The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China"},{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Chun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Atlanta VA Medical Center, The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7756-2314","authenticated-orcid":false,"given":"Jose","family":"de Leon","sequence":"additional","affiliation":[{"name":"Mental Health Research Center, Eastern State Hospital, Lexington, USA"},{"name":"Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain"},{"name":"Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Ap\u00f3stol Hospital, University of the Basque Country, Vitoria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,1,2]]},"reference":[{"key":"bibr1-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1994.tb04385.x"},{"key":"bibr2-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1177\/00912700122010717"},{"key":"bibr3-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e3181acc372"},{"key":"bibr4-0091217417749799","first-page":"599","volume":"96","author":"Chang WH","year":"1997","journal-title":"J Formos Med 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Elevated clozapine levels associated with infection: a systematic review.\n                      Schizophr Res.\n                      Epub ahead of print 6 April 2017. DOI: 10.1016\/j.schres.2017.03.045.","DOI":"10.1016\/j.schres.2017.03.045"},{"key":"bibr13-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.114.061093"},{"key":"bibr14-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e3181acd20b"},{"key":"bibr15-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1286287"},{"key":"bibr16-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.135.1.99"},{"key":"bibr17-0091217417749799","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-199604000-00016"},{"key":"bibr18-0091217417749799","doi-asserted-by":"crossref","unstructured":"Ruan CJ, Zhen XY, Ge XL, et al. 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