Multiple extremely overdose of antipsychotics with minimal side effects: A case report

BackgroundLiver cytochrome P450 (CYP450) enzymes play an important role in metabolizing antipsychotics (APs) and other drugs.Excessive use of drugs can impair liver function and even other organs, thus causing several adverse effects.In addition, metabolizer types of CYP450 enzymes may influence the therapeutic effects and drug reactions.In this case report, we introduce a 52-year-old female with a 23-year history of schizophrenia who took overdose of multiple kinds of APs and other herbal preparations together for nearly two years, and she presented with poor treatment effects and minor side effects of APs.This case adds clinical examples for those patients with poor efficacy and alarming drug tolerance. Case presentationAt admission, the patient showed obviously positive symptoms.She urgently underwent a drug concentration test, and was considered "drug intoxication".She was given an emergency infusion to increase drug excretion.The drug treatment of the patient was adjusted.After pharmacogenomic examination, we found this patient was a CYP1A2 ultra-rapid metabolizer.At discharge, the clinical symptoms of the patient have decreased, and her condition was stable. ConclusionsCYP1A2 ultra-rapid metabolizer may explain part of the poor therapeutic effects and small adverse effects in this case who took multiple kinds of overdose drugs.Many factors may be involved in the rare presentations in this patient.