A 37-year-old male with schizophrenia is, as a single drug treatment, receiving clozapine (Leponex)

Fråga: A 37-year-old male with schizophrenia is, as a single drug treatment, receiving clozapine (Leponex) 325 mg daily. The patient has developed tachycardia, hypersalivation and excessive sweating as adverse reactions. Liver enzyme ALAT was increased to 1.0. Could clozapine induce hyperhidrosis?

Sammanfattning: No reports have been found concerning clozapine and hyperhidrosis, but it cannot be excluded that the observed hyperhidrosis in this case is caused by the clozapine treatment.

Svar: Clozapine is an atypical high-dose neuroleptic, a dibenzodiazepin derivative with antipsychotic effect. It has a wide range of interactions with other neurotransmittor systems. These include strong antinoradrenergic actions, antihistaminergic actions, antiserotoninergic actions, anticholinergic actions, and interactions with GABAergic systems. It has a weak dopamine receptor blocking effect (1, 2).

Symptomatic adverse effects of clozapine such as tachycardia and hypersalivation are well known. An increase in liver enzymes is also a well known adverse reaction to clozapine. The drug has been reported to cause an influena-like syndrome with fever (1, 3). However, no documentation of hyperhidrosis associated with clozapine has been found in the literature, including the database Medline and the files of the Swedish Adverse Drug Reactions Advisory Committee (SADRAC).

The sweat glands are innervated by sympathetic cholinergic nerve fibres, but are stimulated primarily by centres in the hypothalamus that are usually considered to be parasympathetic. The mechanism behind sweating as an adverse reaction to clozapine is unclear. Central mechanisms may be involved.

If no other reasons for the hyperhidrosis can be found, we recommend that this case be reported to the Swedish Adverse Drug Reactions Advisory Committee.