CAN SEVERE CARDIORESPIRATORY DYSREGULATION INDUCED BY CLOZAPINE MONOTHERAPY BE PREDICTED

Severe orthostatic and cardiorespiratory dysregulation may occur durin g institution of clozapine therapy both during concomitant benzodiazep ine medication and on reinstitution of clozapine after a washout perio d. Extensive medical and neurological workup before and after the tria ls can nevertheless be normal. The absence of similar previous reactio ns to other drugs, adhering to monotherapy with clozapine, increasing dosage slowly or performing a single test for orthostatic reactions af ter initiating clozapine are insufficient precautionary measures. Card iorespiratory complications can occur without the challenge of assumin g an erect position but appear to otherwise run an initial course simi lar to that of severe orthostatic reactions. A significantly abnormal response to testing for orthostatic reactions may be established, but only during the period of vulnerability to cardiorespiratory dysregula tion. Repeated testing for this predisposition during the first weeks of clozapine therapy is suggested.