{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T03:21:05Z","timestamp":1777432865317,"version":"3.51.4"},"reference-count":13,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2018,5,8]],"date-time":"2018-05-08T00:00:00Z","timestamp":1525737600000},"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":["Australas Psychiatry"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To illustrate the complexities of clozapine metabolism with the use of therapeutic drug monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We describe a case of clozapine toxicity in a patient with schizophrenia treated with the combination of clozapine, valproate and haloperidol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A 24-year-old CYP2D6 poor metaboliser developed clozapine toxicity corresponding to the additive effects of haloperidol, and increasing clozapine and valproate doses. Saturation of metabolism, evidenced by a high clozapine\/norclozapine ratio, was present at this time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Clozapine metabolism is complex and influenced by multiple factors, including interactions with hepatic P450 enzyme inducers\/inhibitors, genetic polymorphisms and the potential for saturation of the N-demethylation metabolic pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1039856218771509","type":"journal-article","created":{"date-parts":[[2018,5,8]],"date-time":"2018-05-08T05:55:32Z","timestamp":1525758932000},"page":"608-611","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Clozapine toxicity in a CYP2D6 poor metaboliser: Additive effects of haloperidol and valproate on clozapine metabolism"],"prefix":"10.1177","volume":"26","author":[{"given":"Robert","family":"Reznik","sequence":"first","affiliation":[{"name":"VMO Consultant Psychiatrist, Long Bay Hospital, Matraville, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rena Yuan Yuan","family":"Chen","sequence":"additional","affiliation":[{"name":"General Practice Registrar, Long Bay Hospital, Matraville, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0338-3444","authenticated-orcid":false,"given":"Phoebe","family":"Stanford","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Registrar, NSW Health Pathology, The Prince of Wales Hospital, Randwick, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,5,8]]},"reference":[{"key":"bibr1-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1177\/00912700122010717"},{"issue":"6","key":"bibr2-1039856218771509","first-page":"255","volume":"55","author":"Kando JC","year":"1994","journal-title":"The Journal of Clinical Psychiatry"},{"key":"bibr3-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-199504000-00011"},{"key":"bibr4-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1177\/0004867416641195"},{"key":"bibr5-1039856218771509","doi-asserted-by":"publisher","DOI":"10.3109\/10401239609148808"},{"key":"bibr6-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.48.2.170"},{"key":"bibr7-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0b013e3181dad1fb"},{"key":"bibr8-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1371866"},{"key":"bibr9-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-199906000-00017"},{"key":"bibr10-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(94)90647-5"},{"key":"bibr11-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.152.4.650a"},{"key":"bibr12-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1046\/j.0306-5251.2001.01474.x"},{"key":"bibr13-1039856218771509","doi-asserted-by":"publisher","DOI":"10.1097\/01.wnf.0000154221.37887.73"}],"container-title":["Australasian Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1039856218771509","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1039856218771509","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1039856218771509","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:49:44Z","timestamp":1777376984000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1039856218771509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,8]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1177\/1039856218771509"],"URL":"https:\/\/doi.org\/10.1177\/1039856218771509","relation":{},"ISSN":["1039-8562","1440-1665"],"issn-type":[{"value":"1039-8562","type":"print"},{"value":"1440-1665","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,8]]}}}