Clozapine-Induced Fevers and 1-Year Clozapine Discontinuation Rate
J Clin Psychiatry 2002;63:880-884
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Clozapine-induced fever is a known
side effect that can occur during clozapine initiation. This
study aims to characterize patients who experience
clozapine-induced fever, the nature of the fevers, and rates of
clozapine continuation at 1 year in patients who develop fever
versus those who do not.
Method: A retrospective chart review of 93
consecutive clozapine initiations (1991-1999) was conducted.
Fever was defined as any 1 temperature at or above 38.0oC
(100.4oF). Demographic information, presence or
absence of clozapine-induced fevers, and continuation of
clozapine treatment at 1 year were extracted from the charts.
These variables were analyzed for significance, and subsample
analysis was conducted for those with more severe fevers (at or
above 38.5oC [101.3oF]).
Results: Of the 93 patients, 20.4% (N =
19) developed clozapine-induced fevers. At 1 year, there was no
significant difference in clozapine discontinuation rate between
those patients who experienced fever and those who did not.
Patients who experienced higher fevers ( 38.5oC [101.3oF])
tended to be significantly older than those who did not (p <
.027). The mean fever duration was 3.8 days (range, 1-9 days),
with a mean temperature of 39.1oC (102.4oF)
(range, 38.0-41.0oC [100.4-105.8oF]). At 1
year, the patients who experienced fever showed no increased risk
of severe reactions such as agranulocytosis. All patients with
fevers continued clozapine treatment with good 1-year
continuation rate on treatment with this medication.
Conclusion: Clozapine-induced fever is not an
indication for discontinuing this effective medication. It is a
benign, self-limited phenomenon not predictive of drug
discontinuation at 1 year. Older age at time of treatment may be
a risk factor for developing clozapine-induced fever.