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A 25-year-old man with treatment-refractory schizophrenia presents to the University of Pittsburgh Medical Center with drowsiness and a fever of 40.3°C, noting that he started treatment with clozapine (Clozaril) about 2 weeks previously and that he has no chest pain.
His medical history includes treatment failures with haloperidol (Haldol), risperidone (Risperdal), and olanzapine (Zyprexa), and there was a recent episode of severe psychosis that led to his starting on clozapine 12.5 mg. The dose had been increased to 250 mg daily over 10 days, with a corresponding improvement in his psychotic symptoms.
At that point, testing showed clozapine serum levels of 287 mcg/L (therapeutic reference range is 350-600 ng/mL). As a result, the prescribing clinicians had increased the dose to 300 mg 1 week prior to his presentation.
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