Cholinergic rebound and rapid onset psychosis following abrupt clozapine withdrawal

Shiovitz, T. M.; Welke, T. L.; Tigel, P. D.; Anand, R.; Hartman, R. D.; Sramek, J. J.; Kurtz, N. M.; Cutler, N. R.

doi:10.1093/schbul/22.4.591

Cited by 105Schizophrenia research and treatmentNeurotransmitter Receptor Influence on BehaviorTreatment of Major Depression

Cholinergic rebound and rapid onset psychosis following abrupt clozapine withdrawal

Shiovitz, T. M., Welke, T. L., Tigel, P. D., Anand, R., Hartman, R. D., Sramek, J. J., Kurtz, N. M., Cutler, N. R.·1996·Schizophrenia Bulletin

DOI 10.1093/schbul/22.4.591

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Abstract

Following the conduct of a 28-day inpatient bioequivalence study of clozapine in schizophrenia patients, withdrawal effects after abrupt discontinuation from clozapine were assessed. Thirty patients who met DSM-III-R criteria for schizophrenia, residual type, or schizophrenia in remission were enrolled in the study. Patients were evaluated for symptoms of withdrawal effects for 7 days after clozapine 200 mg/day was abruptly withdrawn. Of 28 patients who completed the study, 11 had no withdrawal symptoms; 12 had mild withdrawal adverse events of agitation, headache, or nausea; four patients experienced moderate withdrawal adverse events of nausea, vomiting, or diarrhea; and one patient experienced a rapid-onset psychotic episode requiring hospitalization. Cholinergic rebound is a likely explanation for the mild to moderate withdrawal symptoms and is easily treated with an anticholinergic agent. Mesolimbic supersensitivity, as well as specific properties of clozapine, are discussed as likely causes for rapidonset psychosis. Our findings are consistent with previous reports of withdrawal reactions associated with clozapine, further reminding clinicians to monitor patients closely following abrupt discontinuation of clozapine.

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Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Advances in biochemical psychopharmacology
Aprison, M. H. (1970) · Neuropharmacology · doi:10.1016/0028-3908(70)90062-6 · Cited by 1,177 · see citing works

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Seeman, P., & Tallerico, T. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.6.876 · Cited by 237 · see citing works
Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal‐related relapse
Moncrieff, J. (2006) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2006.00787.x · Cited by 231 · see citing works
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Huyse, F. J., Touw, D. J., van Schijndel, R. J. M. S., de Lange, J. J., & Slaets, J. P. J. (2005) · Psychosomatics · doi:10.1176/appi.psy.47.1.8 · Cited by 123 · see citing works
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Effect of switching to atypical antipsychotics on memory in patients with chronic schizophrenia
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Patchan, K. M., Vyas, G. R., Hackman, A. L., Mackowick, M., Richardson, C. M., Love, R. C., Wonodi, I., Sayer, M. A., Glassman, M., Feldman, S. M., et al. (2017) · Psychiatric Quarterly · doi:10.1007/s11126-017-9521-z · Cited by 51 · see citing works
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Waddington, J. L., Scully, P. J., & O’Callaghan, E. (1997) · Schizophrenia Research · doi:10.1016/s0920-9964(97)00115-1 · Cited by 42 · see citing works
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Leung, J. G., Hasassri, E., Barreto, J. N., Nelson, S. Y., & Morgan, R. J. (2016) · Psychosomatics · doi:10.1016/j.psym.2016.11.013 · Cited by 41 · see citing works
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Myles, N., Myles, H., Clark, S. R., Bird, R. J., & Siskind, D. J. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417720516 · Cited by 39 · see citing works
Effect of Anticholinergics in Preventing Acute Deterioration in Patients Undergoing Abrupt Clozapine Withdrawal
l, N. S., Kovio, C., & Leinonen, E. V. J. (2005) · CNS Drugs · doi:10.2165/00023210-200519120-00006 · Cited by 36 · see citing works
Clozapine treatment attenuated somatic and affective signs of nicotine and amphetamine withdrawal in subsets of rats exhibiting hyposensitivity to the initial effects of clozapine
Semenova, S., & Markou, A. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00240-3 · Cited by 34 · see citing works
Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia
Qubad, M., & Bittner, R. A. (2023) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253231158152 · Cited by 33 · see citing works
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Chiappini, S., Schifano, F., Corkery, J. M., & Guirguis, A. (2020) · Brain Sciences · doi:10.3390/brainsci10020105 · Cited by 33 · see citing works
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Osser, D. N., & Sigadel, R. (2001) · Harvard Review of Psychiatry · doi:10.1080/10673220127892 · Cited by 30 · see citing works
Combination of ziprasidone and clozapine in treatment‐resistant schizophrenia
Zink, M., Mase, E., & Dreßing, H. R. (2004) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.580 · Cited by 24 · see citing works
What is the clinical significance of the discontinuation syndrome seen with clozapine?
Goudie, A. J. (2000) · Journal of Psychopharmacology · doi:10.1177/026988110001400212 · Cited by 24 · see citing works
A case report of cholinergic rebound syndrome following abrupt low-dose clozapine discontinuation in a patient with type I bipolar affective disorder
Galova, A., Berney, P., Desmeules, J. A., Sergentanis, I. N., & Besson, M. J. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2055-1 · Cited by 23 · see citing works
Clozapine withdrawal symptoms in a Parkinson's disease patient
Zesiewicz, T. A., Borra, S., & Hauser, R. A. (2002) · Movement Disorders · doi:10.1002/mds.10282 · Cited by 23 · see citing works
Treatment strategies for clozapine-induced hypotension: a systematic review
Tanzer, T. D., Brouard, T., Pra, S. E. D., Warren, N., Barras, M. A., Kisely, S. R., Brooks, E., & Siskind, D. J. (2022) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253221092931 · Cited by 24 · see citing works
Case Report: Clozapine use in two women with schizophrenia during pregnancy
Duran, A., Uğur, M., Turan, Ş., & Emül, M. (2007) · Journal of Psychopharmacology · doi:10.1177/0269881107079171 · Cited by 20 · see citing works
Converting from brand-name to generic clozapine: A review of effectiveness and tolerability data
Bobo, W. V., Stovall, J., Knostman, M., Koestner, J., & Shelton, R. C. (2009) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp080595 · Cited by 19 · see citing works
Clozapine
Hill, M. B., & Freudenreich, O. (2013) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.hifr.01062013 · Cited by 17 · see citing works
Clozapine-olanzapine: a potentially dangerous switch. A report of two cases
Delassus-Guenault, N., Jegouzo, A., Odou, P., Seguret, T., Zangerlin, H., Vignole, E., & Robert, H. (1999) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1046/j.1365-2710.1999.00218.x · Cited by 17 · see citing works
When, Why and How to Re-challenge Clozapine in Schizophrenia Following Myocarditis
Qubad, M., Dupont, G., Hahn, M., Martin, S. S., Püntmann, V. O., Nagel, E. C., Reif, A., & Bittner, R. A. (2024) · CNS Drugs · doi:10.1007/s40263-024-01100-4 · Cited by 20 · see citing works
Long-Acting Injectable Risperidone and Hospital Readmission
Chang, H.-C., Tang, C., Tsai, S., Yen, F.-C., & Su, K. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08l04447 · Cited by 14 · see citing works
The debate regarding maintenance treatment with antipsychotic drugs in schizophrenia
Davidson, M. (2018) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2018.20.3/mdavidson · Cited by 14 · see citing works
Clozapine Withdrawal Catatonia Refractory to ECT: A Case Report
Cerit, C., Tuzun, B., Aslan, E. A., & Şahan, E. (2012) · Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology · doi:10.5455/bcp.20120731051540 · Cited by 14 · see citing works
Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review
Yee, B., Looi, J. C., Agaciak, M., Allison, S. C., Chan, S. K. W., & Bastiampillai, T. J. (2023) · East Asian Archives of Psychiatry · doi:10.12809/eaap2261 · Cited by 13 · see citing works
Fluctuation between cigarette smoking and use of electronic nicotine delivery systems: Impact on clozapine concentrations and clinical effect
Montville, D. J., Lindsey, J. M., & Leung, J. G. (2021) · Mental Health Clinician · doi:10.9740/mhc.2021.11.365 · Cited by 12 · see citing works
Switching bipolar disorder patients treated with clozapine to another antipsychotic medication: a mirror image study
Ifteni, P. I., Teodorescu, A., Moga, M., Pascu, A. M., & Miclăuș, R. S. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s122367 · Cited by 12 · see citing works
Targeted Treatment of Schizophrenia Symptoms as They Manifest, or Continuous Treatment to Reduce the Risk of Psychosis Recurrence
Davidson, M., & Carpenter, W. T. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad145 · Cited by 10 · see citing works
Switching strategies for antipsychotic monotherapy in schizophrenia: a multi-center cohort study of aripiprazole
Obayashi, Y., Mitsui, S., Sakamoto, S., Minao, N., Yoshimura, B., Kono, T., Yada, Y., Okahisa, Y., Takao, S., Kishi, Y., et al. (2019) · Psychopharmacology · doi:10.1007/s00213-019-05352-7 · Cited by 11 · see citing works
Schizophrenia Patients Discharged on Clozapine Plus Long-Acting Injectable Antipsychotics From a Public Psychiatric Hospital in Taiwan, 2006–2021
Lin, T.-C., & Lin, C. (2023) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyad053 · Cited by 9 · see citing works
Clozapine therapy throughout myelosuppressive chemotherapy: regulations without standardization
Barreto, J. N., Leung, J. G., Philbrick, K. L., Rasmussen, K. G., & Thompson, C. A. (2015) · Psycho-Oncology · doi:10.1002/pon.3779 · Cited by 9 · see citing works
Combating psychosis in Parkinson’s disease patients: the use of antipsychotic drugs
Chou, K. L., & Fernandez, H. H. (2006) · Expert Opinion on Investigational Drugs · doi:10.1517/13543784.15.4.339 · Cited by 9 · see citing works
Aripiprazole-Induced Agitation After Clozapine Discontinuation
Cho, D. Y., & Lindenmayer, J. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08l04528 · Cited by 9 · see citing works
High-dose Clozapine Withdrawal: A Case Report and Timeline of a Single Potential Withdrawal Seizure.
Skelly, M. K., Demler, T. L., & Lee, C. (2019) · PubMed Central · Cited by 9 · see citing works
Pharmacist‐driven discontinuation of antipsychotics for ICU delirium: A quasi‐experimental study
Stuart, M., Smith, Z., Payter, K., Martz, C. R., To, L., Swiderek, J. L., Coba, V. E., & Peters, M. A. (2020) · JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY · doi:10.1002/jac5.1234 · Cited by 9 · see citing works
Polyserositis, Acute Withdrawal, and Relapse After Abrupt Clozapine Discontinuation
Malhotra, S., Franco, K. S. N., Tomford, J. W., & Iqbal, R. (2002) · Psychosomatics · doi:10.1176/appi.psy.43.5.418 · Cited by 9 · see citing works
Clozapine lacks previous clinical efficacy when restarted after a period of discontinuation: A case series
GRASSI, B., Ferrari, R., Epifani, M., Dragoni, C., Cohen, S., & Scarone, S. (1999) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(99)00031-0 · Cited by 9 · see citing works
Clozapin-Augmentation mit atypischen Antipsychotika
Zink, M., & Dreßing, H. R. (2005) · Der Nervenarzt · doi:10.1007/s00115-005-1887-8 · Cited by 8 · see citing works
Schizophrenia and Related Psychoses
(2021) · Wiley eBooks · doi:10.1002/9781119870203.mpg001 · Cited by 8 · see citing works
The Co-occurrence of Gastrointestinal Symptoms and Psychosis
Colijn, M. A. (2022) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.22nr03236 · Cited by 7 · see citing works
Neuroleptic-Induced Catatonia in Two Hospitalized Patients
Gugger, J. J., Saad, M., & Smith, C. J. (2011) · Journal of Pharmacy Practice · doi:10.1177/0897190011420159 · Cited by 7 · see citing works
Psychotropic discontinuation leading to an NMS‐like condition
Kurien, R., & Vattakatuchery, J. J. (2013) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.297 · Cited by 6 · see citing works
Implications for anaesthesia in a patient established on clozapine treatment
Doherty, J., Bell, P., & King, D. J. (2005) · International Journal of Obstetric Anesthesia · doi:10.1016/j.ijoa.2005.04.015 · Cited by 6 · see citing works
Failure of Induced Hypertension for Symptomatic Vasospasm in the Setting of Clozapine Therapy
Leung, J. G., Nelson, S. Y., & Hocker, S. E. (2015) · Neurocritical Care · doi:10.1007/s12028-015-0129-6 · Cited by 6 · see citing works
Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review
Boazak, M., Kahn, B., Cox, L., Ragazino, J., Goldsmith, D. R., & Cotes, R. O. (2018) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.boka.061518 · Cited by 5 · see citing works
Closure beyond clozapine: successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis
Green, A., Stephenson, T., Whiskey, E., & Shergill, S. S. (2019) · BJPsych Open · doi:10.1192/bjo.2019.31 · Cited by 5 · see citing works
Management of Cholinergic Rebound After Abrupt Withdrawal of Clozapine: A Case Report and Systematic Literature Review
Bickerton, L., & Kuriakose, J. L. (2023) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2023.10.001 · Cited by 4 · see citing works
Clozapine pre-treatment enhances raclopride catalepsy
Wadenberg, M.-L. G., & Seeman, P. M. (1999) · European Journal of Pharmacology · doi:10.1016/s0014-2999(99)00406-9 · Cited by 4 · see citing works
Clozapine Withdrawal Catatonia: A Case Report
Jagtiani, A., Nagi, T., Gandhi, R., & Rizvi, A. (2024) · Cureus · doi:10.7759/cureus.52462 · Cited by 3 · see citing works
Aggressive behaviour in schizophrenic patients after abrupt treatment discontinuation
Kapsali, F., Rabavilas, A. D., Michopoulou, A., Papadimitriou, G. N., & Papageorgiou, C. (2011) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2011.589517 · Cited by 3 · see citing works
The effect of second-generation antipsychotic withdrawal on the occurrence of vacuous chewing movements in animal models: A review
Brandt, L., Montag, C., Bermpohl, F., Finck, A., Wieacker, E., Heinz, A., & Gutwinski, S. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2021.113637 · Cited by 3 · see citing works
Treatment resistant catatonia secondary to clozapine withdrawal
Nasr, Y., & Ganapathy, R. (2015) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.404 · Cited by 3 · see citing works
Optimizing Clozapine Treatment
Phansalkar, S., & Osser, D. N. (2009) · Psychopharm Review · doi:10.1097/01.idt.0000343379.44905.2f · Cited by 3 · see citing works
Optimizing Clozapine Treatment
Phansalkar, S., & Osser, D. N. (2009) · Psychopharm Review · doi:10.1097/01.idt.0000343814.12380.d4 · Cited by 3 · see citing works
Clozapine: the first atypical antipsychotic
Naber, D., Haasen, C., & Perro, C. (2000) · Birkhäuser Basel eBooks · doi:10.1007/978-3-0348-8448-8_8 · Cited by 3 · see citing works
Serotonin Syndrome and Catatonia in the Absence of a Serotonergic Agent Following Abrupt Withdrawal of Clozapine
Wu, H., & Hill, V. (2024) · The Canadian Journal of Hospital Pharmacy · doi:10.4212/cjhp.3452 · Cited by 2 · see citing works
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Restrepo, J. A., Rosenbaum, B. L., Harris, D., Gift, T., & Freudenreich, O. (2025) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2025.05.007 · Cited by 2 · see citing works
An Unusual Cause of Delirium in a Psychiatric Patient: Abrupt Clozapine Discontinuation
Wong, O., Fung, H., & Lam, T. (2010) · Hong Kong Journal of Emergency Medicine · doi:10.1177/102490791001700210 · Cited by 2 · see citing works
Amisülpirid Kesilmesini İzleyen Okülerjik Krizin Eşlik Ettiği Psikotik Alevlenme: Olgu Sunumu
Özcan, S., Tamam, L., & Soydan, A. (2013) · Nöro Psikiyatri Arşivi · doi:10.4274/npa.y6411 · Cited by 2 · see citing works
Medication-Free Minors With Schizophrenia
Cohen, D. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.2.324 · Cited by 2 · see citing works
A Case Report of Probable Neuroleptic Malignant Syndrome
McCullough, A., Stroup, J. S., & Brahm, N. C. (2013) · Journal of Pharmacy Technology · doi:10.1177/8755122513500917 · Cited by 1 · see citing works
Antipsychotics: Clinical Effectiveness
Freudenreich, O. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-29450-2_16 · Cited by 1 · see citing works
Use of Clozapine in the General Hospital
Mustafa, F. A. (2025) · Psychopharmacology Bulletin · doi:10.64719/pb.4617 · Cited by 1 · see citing works
Rapid-Onset Psychosis and Cholinergic Rebound After Abrupt Discontinuation of Clozapine
Palkar, P., Garces, E., Chavali, S., Zubair, A. S., & Hashmi, S. (2021) · Psychiatric Annals · doi:10.3928/00485713-20210105-01 · Cited by 1 · see citing works
Schizophrenia and Related Psychoses
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Takeshita, J., Thompson, D. S., & Nicolson, S. E. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511543784.023
Overdiagnosis and Underdiagnosis of Bipolar Disorder
Manning, J. S., & Kane, M. E. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08lr04522
Clozapine Withdrawal Syndrome
Dubovsky, S. L. (1997) · Journal watch · doi:10.1056/jp199702010000008
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Clozapine
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Ruggero, C. J., & Zimmerman, M. A. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08lr04522a
Schizophrenia Bulletin Index: 1996-97
(1997) · Schizophrenia Bulletin · doi:10.1093/schbul/23.4.701
Discontinuing Clozapine and Management of Cholinergic Rebound
Meyer, J. M., & Stahl, S. M. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108553575.006

Authors: Shiovitz, T. M., Welke, T. L., Tigel, P. D., Anand, R., Hartman, R. D., Sramek, J. J., Kurtz, N. M., & Cutler, N. R.
Affiliations: Clinical Trials of Texas (US)
Worldwide Clinical Trials (United States) (US)
Corresponding author: Shiovitz, T. M.
Cutler, N. R.
ORCID: Anand, R.
Hartman, R. D.
Sramek, J. J.
Cutler, N. R.
Venue: Schizophrenia Bulletin
Publisher: Oxford University Press (OUP)
Published: 1996-01-01
Volume: 22
Issue: 4
Pages: 591-595
ISSN: 0586-7614 (ISSN-L)
1745-1701
DOI: 10.1093/schbul/22.4.591
OpenAlex: W2137941062
Semantic Scholar: f2d25e1e9ea9112b298df79e9e1d15f8eafa939c
Cited by: 104
References: 2
Citations by year: 2026: 3 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 7 · 2020: 3 · 2019: 8 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 4 · 2013: 5 · 2012: 2
FWCI: 2.84
Type: journal article
Language: en
Open access: closed
Locations: Schizophrenia Bulletin (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords: clozapine, drug withdrawal
MeSH terms: Adolescent, Adult, Clozapine, Diarrhea, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Nausea, Neurologic Examination, Psychoses, Substance-Induced, Receptors, Cholinergic, Schizophrenia, Schizophrenic Psychology, Substance Withdrawal Syndrome, Antipsychotic Agents, Vomiting, Akathisia, Drug-Induced

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Cholinergic rebound and rapid onset psychosis following abrupt clozapine withdrawal

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