Plasma clozapine levels and the treatment of l-dopa-induced psychosis in Parkinson’s disease a high potency effect of clozapine

Herbert Y. Meltzer*, John Kennedy, Jin Dai, Mahmoud Parsa, David Riley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

The purpose of this study was to determine the plasma level of clozapine and its metabolite, N-desmethylcloza- pine, in Parkinson’s disease patients with L-DOPA- induced psychosis responsive to clozapine. The psychotic symptoms of the three patients studied responded to low doses of clozapine with plasma levels of clozapine between 4.5 and 16.1 ng/ml and N-desmethylclozapine between 2.6 and 6.1 ng/ml, much below the plasma clozapine levels usmlly found in clozapine-treated refractory schizophrenia or affective disorders (range 100 to 687 ng/ml). Possible mechanisms that may account for clozapine's antipsychotic action in dopaminomimetic- induced psychosis in Parkinson's disease, including serotonimA (5-HT2a) and dopamine Di receptor blockade, at plasma levels that would be ineffective in refractory schizophrenia, are discussed. It is suggested that 5-HT2A receptor blockade is the most likely basis for the effectiveness of clozapine in L-DOPA psychosis.

Original languageEnglish (US)
Pages (from-to)39-45
Number of pages7
JournalNeuropsychopharmacology
Volume12
Issue number1
DOIs
StatePublished - Feb 1995

Keywords

  • Clozapine
  • L-DOPA
  • Parkinson's Disease
  • Psychosis

ASJC Scopus subject areas

  • Pharmacology
  • Psychiatry and Mental health

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