International Journal of Clinical Pharmacy

, Volume 37, Issue 6, pp 992–995 | Cite as

Eosinophilia and parotitis occurring early in clozapine treatment

  • Bochra Nourhène SaguemEmail author
  • Saoussen Bouhlel
  • Chaker Ben Salem
  • Bechir Ben Hadj Ali
Case Report


Case presentation

Mr. S is a 32-year-old male with schizophrenia. Due to poor responses to various antipsychotic medications, he was started on clozapine with the dose titrated to 300 mg/day during a 4-week period. The weekly checks of the complete blood cell count showed gradual increases in the eosinophil count from normal values to 4320 per mm3. Mr. S did not have any symptoms except some increased salivation. Clozapine was suspended, and eosinophils gradually began to decline to the normal range. Clozapine was subsequently re-started and there were no changes in eosinophil counts. Mr. S exhibited improvement of symptoms but complained of acute auricular pain and increased salivation, 8 weeks after clozapine rechallenge. He also developed a swelling of his both parotid glands. The diagnosis of clozapine-induced parotitis was suggested. Symptomatic medication was prescribed with a favorable outcome.


We report a case of a patient who developed eosinophilia shortly after clozapine use, and then developed parotitis. There is debate in the literature over how to manage these complications of clozapine treatment. Generally they do not warrant clozapine discontinuation.


Clozapine Eosinophilia Parotitis Schizophrenia 




Conflicts of interest



  1. 1.
    Wenthur CJ, Lindsley CW. Classics in chemical neuroscience: clozapine. ACS Chem Neurosci. 2013;4(7):1018–25.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Meltzer HY. Update on typical and atypical antipsychotic drugs. Annu Rev Med. 2013;64:393–406.CrossRefPubMedGoogle Scholar
  3. 3.
    Bailey P. Clozapine treatment, eosinophilia and agranulocytosis. Br J Psychiatry. 1997;171:90.CrossRefPubMedGoogle Scholar
  4. 4.
    Kontoangelos K, Loizos S, Kanakakis J, Smyrnis N, Economou M, Bergiannaki JD, et al. Myocarditis after administration of clozapine. Eur Rev Med Pharmacol Sci. 2014;18(16):2383–6.PubMedGoogle Scholar
  5. 5.
    Brooks KG, Thompson DF. A review and assessment of drug-induced parotitis. Ann Pharmacother. 2012;46(12):1688–99.CrossRefPubMedGoogle Scholar
  6. 6.
    Frankenburg FR, Kando J. Eosinophilia, clozapine, and pancreatitis. Lancet. 1992;340(8813):251.CrossRefPubMedGoogle Scholar
  7. 7.
    Fong SY, Au Yeung KL, Tosh JM, Wing YK. Clozapine-induced toxic hepatitis with skin rash. J Psychopharmacol. 2005;19(1):107.CrossRefPubMedGoogle Scholar
  8. 8.
    Karmacharya R, Mino M, Pirl WF. Clozapine-induced eosinophilic colitis. Am J Psychiatry. 2005;162(7):1386–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Base de données publique des médicaments. (2015). Leponex 100 mg, [en ligne].
  10. 10.
    Roberts CE, Mortenson LY, Merrill DB, Rafizadeh N, Smith TE, Lieberman JA. Successful rechallenge with clozapine after eosinophilia. Am J Psychiatry. 2011;168(11):1147–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Schuepbach D, Merlo MC, Kaeser L, Brenner HD. Successful challenge with clozapine in a history of eosinophilia. Int Clin Psychopharmacol. 1998;13(1):33–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Floreani J, Bastiampillai T. Successful re-challenge with clozapine following development of clozapine-induced cardiomyopathy. Aust N Z J Psychiatry. 2008;42(8):747–8.PubMedGoogle Scholar
  13. 13.
    Himmerich H, Schönherr J, Fulda S, Sheldrick AJ, Bauer K, Sack U. Impact of antipsychotics on cytokine production in-vitro. J Psychiatr Res. 2011;45(10):1358–65.CrossRefPubMedGoogle Scholar
  14. 14.
    Lucht MJ, Rietschel M. Clozapine-induced eosinophilia: subsequent neutropenia and corresponding allergic mechanisms. J Clin Psychiatry. 1998;59(4):195–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Roge R, Moller BK, Andersen CR, Correll CU, Nielsen J. Immunomodulatory effects of clozapine and their clinical implications: what have we learned so far? Schizophr Res. 2012;140(1–3):204–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Simon D, Simon HU. Eosinophilic disorders. J Allergy Clin Immunol. 2007;119(6):1291–300.CrossRefPubMedGoogle Scholar
  17. 17.
    Sperner-Unterweger B, Gaggl S, Fleischhacker WW, Barnas C, Herold M, Geissler D. Effects of clozapine on hematopoiesis and the cytokine system. Biol Psychiatry. 1993;34(8):536–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Martin SD. Drug-induced parotid swelling. Br J Hosp Med. 1993;50(7):426.PubMedGoogle Scholar
  19. 19.
    Hinze-Selch D, Becker EW, Stein G, Schreiber W, Pollmächer T. Clozapine-induced parotitis: an immunological cause? Am J Psychiatry. 1996;153(6):840.PubMedGoogle Scholar
  20. 20.
    Robinson D, Fenn H, Yesavage J. Possible association of parotitis with clozapine. Am J Psychiatry. 1995;152(2):297–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Vasile JS, Steingard S. Clozapine and the development of salivary gland swelling: a case study. J Clin Psychiatry. 1995;56(11):511–3.PubMedGoogle Scholar
  22. 22.
    Davé M. Iatrogenic salivary gland swelling. J Pharm Technol. 1995;11:18–20.Google Scholar
  23. 23.
    Brodkin ES, Pelton GH, Price LH. Treatment of clozapine-induced parotid gland swelling. Am J Psychiatry. 1996;153(3):445.PubMedGoogle Scholar
  24. 24.
    Patkar AA, Alexander RC. Parotid gland swelling with clozapine. J Clin Psychiatry. 1996;57(10):488.CrossRefPubMedGoogle Scholar
  25. 25.
    Southhall K, Fernando N. Report of a rare medical complication on clozapine. Aust NZ J Psychiat. 1999;33:122–3.CrossRefGoogle Scholar
  26. 26.
    McKay D. Perhaps not so rare? Aust NZ J Psychiat. 2000;34(2):340–1.Google Scholar
  27. 27.
    Gouzien C, Valiamé A, Misdrahi D. Clozapine-induced parotitis: a case study. L’encéphale. 2014;40:81–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Praharaj SK, Arora M, Gandotra S. Clozapine-induced sialorrhea: pathophysiology and management strategies. Psychopharmacology. 2006;185(3):265–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Bai YM, Lin CC, Chen JY, Liu WC. Therapeutic effect of pirenzepine for clozapine-induced hypersalivation: a randomized, double-blind, placebo-controlled, cross-over study. J Clin Psychopharmacol. 2001;21(6):608–11.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Bochra Nourhène Saguem
    • 1
    Email author
  • Saoussen Bouhlel
    • 1
  • Chaker Ben Salem
    • 2
  • Bechir Ben Hadj Ali
    • 1
  1. 1.Department of PsychiatryFarhat Hached University HospitalSousseTunisia
  2. 2.Department of Clinical PharmacologyFaculty of Medicine of SousseSousseTunisia

Personalised recommendations