Prothipendyl Hydrochloride

It is already known that coronavirus disease 2019 (COVID-19) and other inflammatory diseases can lead to elevated clozapine blood concentrationsIn these conditions, therapeutic drug monitoring of clozapine may help maintain clozapine drug concentrations within the therapeutic reference range, as adequate dose titration of clozapine during infectious diseases can prevent serious adverse drug reactions and intoxication.We report about a case of increased clozapine blood concentrations after second COVID-19 vaccination with Spikevax (COVID-19 Vaccine Moderna).A 42-yr-old man (born in Eritrea) with diagnosis of paranoid schizophrenia (F20.0) was admitted in Dec. 2019 in the forensic psychiatric hospital in Riedstadt.The patient had no history of COVID-19 before immunization and was not febrile at any time.He was tested for COVID-19 two times (Sept. 18, 2020 COVID-19 rapid test, Dec. 07, 2020 COVID-19 PCR test), and in Apr. 2021, he received the first COVID-19 vaccination with Spikevax (COVID-19 Vaccine Moderna) without noticeable problems.Prothipendyl (80 mg), haloperidol (8 mg), and lorazepam (2 mg) were prescribed during this time, and because of nonresponse to several antipsychotic drugs, clozapine therapy was started in May 2021, in combination with haloperidol and lorazepam.Clozapine concentration at the day of vaccination was 270 ng/mL and, therefore, below the therapeutic reference range.Leukocytes, neutrophils, monocytes, and lymphocytes were without noticeable problems also after the second vaccination, eosinophils were above the ordinary range (possibly due to an allergic reaction).C-reactive protein (CRP) was slightly increased at the day and for weeks after the second vaccination (6 - 18 mg/L) without signs of a bacterial/viral infection.Glutamate-pyruvate transaminase and γ-glutamyl transferase were slightly above the therapeutic range.In conclusion, we emphasize that (1) patients on clozapine ought to be a high priority for vaccination, (2) the results reported do not imply that treatment with clozapine is a contraindication to vaccination, and (3) the results do not imply that clozapine should not be initiated in vaccinated patients.

At least 170 approved drugs are linked to QT prolongation, which can lead to serious adverse drug reactions (ADRs), such as Torsade de Pointes (TdP). The aim of this study was to analyze the prevalence and type of pharmacodynamic drug-drug interactions (DDIs) between QT-prolonging drugs in psychiatry. The present retrospective analysis used data from a large pharmacovigilance study, conducted in 10 psychiatric hospitals in Germany. Patients medication lists were screened for QT-prolonging drugs, classified according to the Arizona Center for Education and Research on Therapeutics (AZCERT). In total, 27,396 patient cases (46% female) with a mean (± standard deviation) age of 47 ± 18 years were included in the study. Altogether, 83% of the cases received at least one and up to eight QT-prolonging drugs at the same time. Combination of drugs with a known or possible risk for TdP (according to the AZCERT) was detected in 13,670 cases (50%). Most frequently prescribed psychotropic high-risk drugs (n = 48,995) were the antipsychotics pipamperone (n = 6202), quetiapine (n = 5718), prothipendyl (n = 4298), and risperidone (n = 4265). The replacement of high-risk drugs such as tricyclic antidepressants, levomepromazine, melperone, and promethazine with more tolerable drugs could avoid 11% of QT-prolonging drugs and increase the tolerability of psychopharmacological treatment. More than 80% of psychiatric patients receive at least one QT-prolonging drug during their hospital stay, and almost 50% of these drugs are combined in clinical practice. For the prevention of cardiac ADRs, the physician should evaluate the risk for QT prolongation for each drug and patient-specific risk factors before prescribing these drugs or drug combinations.