Total smoking cessation and clozapine treatment - a diabetogenic combination?
Brown, Adrian R.
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Presents the case report of a series of five patients, all from one consultant psychiatrist's caseload of twenty inpatients detained on the same ward in a high-secure psychiatric hospital in England. All five stopped smoking following a hospital-wide smoking ban implemented on 1st April 2007. Prior to the ban, improvements had been made in screening procedures and monitoring for patients receiving clozapine. Each patient was prescribed a therapeutic dose of clozapine both before and after the smoking ban. All five developed type 2 diabetes mellitus during the 3 months after the ban. Each patient gave informed written consent for inclusion in anonymized research relating to the smoking ban and their treatment. The five cases appeared in quick succession. We conclude that the diabetic status of patients about to undergo total smoking cessation must be very closely monitored throughout and for many months postcessation. The clozapine serum level in patients about to quit smoking must also be closely monitored and, given that a rapid rise in serum level may be a trigger, consideration should be given to a pre-emptive dose reduction. However, because large serum level rises are not ubiquitous, this carries with it a risk of patients experiencing a suboptimal serum level for a period and possibly suffering a consequent relapse. (PsycINFO Database Record (c) 2016 APA, all rights reserved)