3 / 22
Page 67
Notes:
conferenceseries
.com
Volume 19, Issue 2 (Suppl)
Int J Emerg Ment Health, an open access journal
ISSN: 1522-4821
Mental Health 2017
June 21-23, 2017
Mental Health and Human Resilience
June 21-23, 2017 London, UK
3
rd
International Conference on
Chao Tian Tang et al., Int J Emerg Ment Health 2017, 19:2(Suppl)
DOI: 10.4172/1522-4821-C1-009
Analyzing interactions: A review of treatment options for schizophrenic patients on Clozapine with
pulmonary tuberculosis
Chao Tian Tang
1
and
Tang Xuan Li
2
1
Institute of Mental Health, Singapore
2
University of Tasmania, Australia
Statement of the Problem:
Studies have observed that the incidence of pulmonary tuberculosis has been significantly higher in
patients with schizophrenia in countries where pulmonary tuberculosis is endemic. Patients on clozapine who are diagnosed with
tuberculosis often present clinicians with a management dilemma. Several anti-tuberculosis medications have significant interactions
with clozapine with isoniazid being an inhibitor of the cytochrome P450 system, increasing the level of clozapine and rifampicin
being an inducer of the cytochrome P450 system decreasing the level of clozapine. To date, clozapine is still the only evidence-based
medication for treatment-refractory schizophrenia.
Orientation:
A literature search was performed on several databases such as PubMed.
Findings:
Patients on lower doses of clozapine could benefit from increasing the dosage of clozapine with monitoring based on
serum clozapine and norclozapine levels and clinical response. Alternatives to rifampicin which have been used in case reports
fluoroquinolones such as ciprofloxacin. However, there is concern about the development of fluoroquinolones resistance in
Mycobacterium tuberculosis
. Streptomycin is another anti-tuberculosis medication; however, there are concerns with streptomycin
given the potential ototoxicity, hepatotoxicity as well as neuropsychiatric manifestations. Conversely, increased plasma concentrations
have been reported with concurrent use of clozapine and isoniazid with such a scenario requiring close monitoring of the patient’s
clozapine and norclozapine level. Clozapine is associated with a dose-dependent seizure risk at a rate higher than that seen with most
other antipsychotic drugs which should be closely monitored.
Conclusion:
Several different management strategies are available based on small anecdotal case reports. No large study has been done
to determine the best treatment option for such patients. Each treatment decision should be tailor-made based on a multidisciplinary
approach for the best outcome.
Biography
Chao Tian Tang is a Psychiatry Resident with the National Healthcare Group, Singapore. He was graduated from the National University of Malaysia and is currently
working at the Institute of Mental Health Singapore. He has experience working in high dependency psychiatric care units, adult neurodevelopmental services and
general psychiatry units. He is actively involved in research and clinical work. His clinical interests include liason psychiatry, neurodevelopmental disorders and
old age psychiatry. He has published articles in the field of old age psychiatry and bibliometrics. He has attended and presented at conferences in fields such as
intellectual disability and neurodevelopmental disorders.
chaotian.tang@mohh.com.sg