Clozapintherapie bei Wirkverlust einer antipsychotischen Einstellung nach Lebertransplantation

After a stepwise change of psychopharmacological treatment, clozapine was established in a patient with previously known paranoid schizophrenia after exacerbation of psychotic symptoms had occurred during liver transplantation and ongoing immunosuppression with tacrolimus. Previous treatment trials with risperidone, paliperidone, quetiapine and olanzapine did not lead to any significant improvement. Within the period shown here of approximately 20 weeks, check-up appointments and monitoring of blood cells took place at weekly intervals, as well as regular laboratory checks of liver and kidney function parameters, metabolic parameters and drug levels. Fluctuations in clozapine levels were probably due to marked variations in nicotine consumption. After the establishment of clozapine, there was a significant improvement in the patient’s general condition.

In retrospect, the deterioration of the psychopathological condition after transplantation might be related to possible adverse neuropsychiatric effects of tacrolimus. In the meantime, movement disorders occurred, which were most likely due to an attempt at antipsychotic therapy with paliperidone and could be acutely and successfully treated with biperiden. Further along after the establishment of clozapine, hypersalivation occurred, which, however, was tolerated by the patient in the context of the overall improvement in the general condition. The continuation of regular multidisciplinary follow-ups, including appropriate laboratory tests, was still intended.