Abstract
Besides the well-known adverse effects of clozapine, such as granulocytopenia, tiredness
and hypersalivation, acute pancreatitis is known to be a very rare complication of
the drug. In the literature a total of five case reports have been published so far.
We report a case of asymptomatic pancreatitis subsequent to clozapine treatment at
therapeutic doses in a 38-year-old male patient with chronic paranoid-hallucinatory
schizophrenia. The patient was rehospitalized after an acute exacerbation of the psychosis
subsequent to an attempt to change medication on an outpatient basis. Treatment with
clozapine was initiated again. During phases of progressively increasing the clozapine
dose, serum levels of amylase and lipase were increased; after maintaining daily doses
of clozapine of 300 mg and/or 600 mg the pancreatic enzymes normalized quickly within
a few days. The patient did not report any pancreas-related complaints, nor did specific
diagnostic studies produce any indicative result, only a minor thickening of the head
and body of the pancreas in the ultrasound. It is assumed that the phenomenon of subclinical,
asymptomatic pancreatitis during increasing dosage of clozapine occurs more often
than previously supposed. The monitoring of serum amylase levels during slow increase
in clozapine is recommended; if leukocytosis or eosinophilia is present, the possibility
of even a subclinical and asymptomatic pancreatitis should be considered.
