Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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A Review on the Cause of Fever During Clozapine Treatment

클로자핀 투약시 나타나는 발열의 원인

  • Jihye, Song (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Sungsuk, Je (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Jaejong, Lee (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Seungyun, Lee (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Seung-Hoon, Lee (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Eunyoung, Lee (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Hyungseok, So (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Hayun, Choi (Department of Psychiatry, Veteran Health Service Medical Center) ;
  • Jinhee, Choi (Department of Psychiatry, Veteran Health Service Medical Center)
  • 송지혜 (중앙보훈병원 정신건강의학과) ;
  • 제성석 (중앙보훈병원 정신건강의학과) ;
  • 이재종 (중앙보훈병원 정신건강의학과) ;
  • 이승윤 (중앙보훈병원 정신건강의학과) ;
  • 이승훈 (중앙보훈병원 정신건강의학과) ;
  • 이은영 (중앙보훈병원 정신건강의학과) ;
  • 소형석 (중앙보훈병원 정신건강의학과) ;
  • 최하연 (중앙보훈병원 정신건강의학과) ;
  • 최진희 (중앙보훈병원 정신건강의학과)
  • Received : 2022.10.31
  • Accepted : 2022.12.04
  • Published : 2022.12.31
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Abstract

Clozapine is accepted as the "gold standard" antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.

클로자핀은 치료 저항성 조현병 약물치료의 "최적 표준(gold standard)"으로 받아들여지고 있다. 클로자핀은 다른 항정신병약물에서 흔히 나타나는 추체외로 증후군, 지연이상 운동증을 거의 일으키지 않고 고프로락틴의 일시적인 상승만 보이는 한편, 발열 등의 약물 이상반응이 흔하게 나타난다. 치료 시작 시기에 드물게 무과립구증, 신경이완제 악성증후군과 같은 치명적인 부작용과 연관된 발열이 발생할 수 있으며, 이 경우 클로자핀을 즉시 중단해야 한다. 그러나 발열의 양성 원인은 생명을 위협하는 부작용보다 훨씬 빈번하므로 치료 시작 시기에 발열을 보이는 경우 무조건 클로자핀을 중단하는 것은 타당하지 않다. 또한, 치료 유지 시기에도 언제든지 발열은 발생할 수 있다. 특히 폐렴의 위험은 시간이 지남에 따라 감소하지 않으며, 클로자핀은 다른 항정신병약물 보다 폐렴의 위험이 높으므로 항상 이를 염두에 두고 치료제 모니터링을 통하여 약물 용량을 결정하는것이 권장된다.

Keywords

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