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Drug Interactions between Clozaril and sars-cov-2 (covid-19) rs-nanoparticle vaccine, recombinant

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

cloZAPine SARS-CoV-2 (COVID-19) NVX-CoV2373 vaccine, recombinant

Applies to: Clozaril (clozapine) and sars-cov-2 (covid-19) rs-nanoparticle vaccine, recombinant

MONITOR: SARS-CoV-2 (COVID-19) vaccines may increase the serum concentrations and adverse effects of clozapine. In one case report, a 51-year-old male with schizoaffective disorder on long-term clozapine (500 mg/day, recently reduced to 300 mg/day after a hospital admission for pneumonia) was hospitalized 4 days after receiving the Pfizer-BioNTech COVID-19 vaccine (2020 - 2021). His clozapine dose was subsequently reduced to 150 mg/day. Upon further investigation, the patient's laboratory test results were consistent with inhibition of CYP450 1A2. The authors theorized that inhibition of drug metabolizing enzymes, including CYP450 1A2, may have been triggered by inflammatory processes from the pneumococcal infection as well as the COVID-19 vaccination. A 2021 multicenter observational cohort study (n=139) observed clinically relevant increases in clozapine blood levels (>100 mcg/L) in 20 patients (22%) after the first COVID-19 vaccine dose and 16 patients (29%) after the second dose. Changes in white blood cell counts for the patients observed in this study did not result in any clinical implications. However, the occurrence of neutropenia or leukopenia in patients on clozapine following the receipt of a COVID-19 vaccine has been documented in other case reports.

MANAGEMENT: SARS-CoV-2 (COVID-19) vaccination is generally both indicated and safe in patients treated with clozapine. However, these patients may benefit from careful evaluation for and additional counseling on signs and symptoms of clozapine toxicity as well as continued monitoring of clozapine levels as indicated.

References

  1. Thompson D, Delorme CM, White RF, Honer WG (2021) "Elevated clozapine levels and toxic effects after SARS-CoV-2 vaccination." J Psychiatry Neurosci, 46, E210-1
  2. Veerman SRT, Moscou T, Bogers JPAM, Cohen D, Schulte PFJ (2022) "Clozapine and COVID-19 vaccination: effects on blood levels and leukocytes. An observational cohort study." Acta Psychiatr Scand, 146, p. 168-78
  3. Demler TL, O'Donnell C (2023) "Exploring the impact of COVID-19 vaccination on patients taking clozapine." Innov Clin Neurosci, 20, p. 32-8
  4. imai t, Ochiai S, ishimaru t, et al. (2022) "A case report: clozapine-induced leukopenia and neutropenia after mRNA COVID-19 vaccination." Neuropsychopharmacol Rep, 42, p. 238-40
View all 4 references

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Drug and food interactions

Moderate

cloZAPine food

Applies to: Clozaril (clozapine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Minor

cloZAPine food

Applies to: Clozaril (clozapine)

Caffeine may increase clozapine serum concentrations and exacerbate psychotic symptoms. The mechanism is unknown but may be related to competition for the same metabolic pathway. No specific intervention is necessary; however, if an interaction is suspected it is recommended that caffeine intake be avoided.

References

  1. Carrillo JA, Jerling M, Bertilsson L (1995) "Interaction between caffeine and clozapine - comment." J Clin Psychopharmacol, 15, p. 376-7
  2. Odom-White A, de Leon J (1996) "Clozapine levels and caffeine." J Clin Psychiatry, 57, p. 175-6
  3. Vainer JL, Chouinard G (1994) "Interaction between caffeine and clozapine." J Clin Psychopharmacol, 14, p. 284
  4. Hagg S, Spiset O, Mjorndal T, Dalqvist R (2000) "Effect of caffeine on clozapine pharmacokinetics in healthy volunteers." Br J Clin Pharmacol, 49, p. 59-63
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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