case_images: PMC5556608_01
case_images: Dose escalation and key events in the course of the patient's clozapine therapy. On Day 334 of clozapine therapy: dose = 400 mg per day, level = 541 ng/ml (pharmacokinetic study results included in the clozapine package insert report peak concentrations of 102-771 ng/ml and minimum steady state concentrations of 41-343 ng/ml). The patient was also on concurrent lithium 300 mg PO BID on Day 1 of clozapine therapy which was subsequently increased to 450 mg PO BID on Day 24 of clozapine therapy. The patient did not demonstrate any symptoms of lithium toxicity.
case_images: CRIPS2017-7359095.001.jpg
case_images: PMC5556608_01_CRIPS2017-7359095.001.jpg
case_images: fig1
case_images: The patient's dose of clozapine was gradually escalated on an outpatient basis and the progress of the dose escalation is summarized in Figure 1.
case_images: Electroencephalogram (EEG) demonstrating microseizures. The EEG was obtained on Day 134 of clozapine therapy [Day 88: clozapine dose escalation to 400 mg per day (with concurrent lithium 450 mg PO BID), Day 109: development of stutter].
case_images: CRIPS2017-7359095.002.jpg
case_images: PMC5556608_01_CRIPS2017-7359095.002.jpg
case_images: fig2
case_images: The study showed an abnormal waking and sleep EEG (Figure 2).