Title:Clozapine and COVID-19: A Case Report and Clinical Considerations
Volume: 17
Issue: 4
Author(s): Dylan Lahiff, Peggy Chatham, Gregory Sullivan and Adam J. Fusick*
Affiliation:
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine,
Tampa, Florida, USA
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa,
Florida, USA
Keywords:
COVID-19, remdesivir, clozapine, schizophrenia, corticosteroids, drug-drug interaction.
Abstract:
Background: The emergence of coronavirus SARS-CoV-2, and the subsequent global
epidemic of COVID-19, brought with it innumerable new clinical experiences across all medical
specialties, and psychiatry is no exception. Individuals with serious mental illness, in particular
schizophrenia and related disorders, may be especially susceptible to coronavirus infection given
the overlapping risk factors of vulnerable sociodemographic status, increased challenges with quarantining
requirements, and limited compliance with “respiratory etiquette.” The case presented
here describes a patient with schizophrenia who was being managed on clozapine and who developed
symptomatic COVID-19 infection. Special care was taken to ensure that potential interactions
between clozapine and the associated COVID-19 treatments were safe for the patient’s mental and
physical wellbeing.
Case Presentation: A 71-year-old schizophrenic Caucasian male is being managed with clozapine.
While hospitalized, the patient was screened positive for COVID-19 and was admitted to the ICU
due to his declining respiratory status. He was treated with both remdesivir and prednisone. He was
able to fully recover from his COVID-19 infection.
Conclusion: The authors review the clinical characteristics of the case, highlighting both the overlapping
synergistic effects and antagonistic influences of clozapine therapy in combination with
COVID-19 and its associated treatments. A review of the literature offers an opportunity to examine
various frameworks for individualized clinical decision-making while making the case for
greater epidemiologic research into the optimal management of individuals with a psychotic disorder
who are diagnosed with COVID-19 infection.
