Clozapine-Induced Microseizures, Orofacial Dyskinesia, and Speech Dysfluency in an Adolescent with Treatment Resistant Early Onset Schizophrenia on Concurrent Lithium Therapy

Figure 1

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 [11]). 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.