Liu JZ, Ma T, Liang ZY, Ning XB, Li WJ, Wang JP, Jin YL, Zhou N, Li JF. Hypertension induced by sudden clozapine withdrawal in a schizophrenia patient with metabolic syndrome: A case report. World J Psychiatry 2026; 16(5): 113723 [DOI: 10.5498/wjp.v16.i5.113723]
Corresponding Author of This Article
Jin-Feng Li, MD, Department of Psychiatry, Hospital for Infectious Diseases, Dongfanghong Farm, Yuguopu Subdistrict, Mengzi City, Honghe Hani and Yi Autonomous Prefecture 661002, Yunnan Province, China. 17145353@qq.com
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Psychiatry
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Case Report
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May 19, 2026 (publication date) through May 5, 2026
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World Journal of Psychiatry
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Liu JZ, Ma T, Liang ZY, Ning XB, Li WJ, Wang JP, Jin YL, Zhou N, Li JF. Hypertension induced by sudden clozapine withdrawal in a schizophrenia patient with metabolic syndrome: A case report. World J Psychiatry 2026; 16(5): 113723 [DOI: 10.5498/wjp.v16.i5.113723]
World J Psychiatry. May 19, 2026; 16(5): 113723 Published online May 19, 2026. doi: 10.5498/wjp.v16.i5.113723
Hypertension induced by sudden clozapine withdrawal in a schizophrenia patient with metabolic syndrome: A case report
Ji-Zhou Liu, Ting Ma, Zi-Yan Liang, Xuan-Bo Ning, Wang-Jin Li, Jian-Ping Wang, Yan-Li Jin, Ning Zhou, Jin-Feng Li
Ji-Zhou Liu, Xuan-Bo Ning, Wang-Jin Li, Jian-Ping Wang, Yan-Li Jin, Jin-Feng Li, Department of Psychiatry, Hospital for Infectious Diseases, Honghe Hani and Yi Autonomous Prefecture, Mengzi 661002, Yunnan Province, China
Ting Ma, Department of Stomatology, The First People’s Hospital of Honghe Prefecture, Honghe Hani and Yi Autonomous Prefecture, Mengzi 661199, Yunnan Province, China
Zi-Yan Liang, Nursing Department, The Third People’s Hospital of Honghe Prefecture, Gejiu 661000, Yunnan Province, China
Ning Zhou, Department of Pharmacy, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Co-first authors: Ji-Zhou Liu and Ting Ma.
Author contributions: Liu JZ, Ma T, and Li JF contributed to original draft preparation; Liu JZ and Ma T contributed equally to this manuscript as co-first authors; Liang ZY and Ning XB contributed to review and edit; Li WJ contributed to conceptualization; Li WJ and Jin YL contributed to methodology, formal analysis and investigation; Li JF contributed to supervision; Liu JZ, Ma T, Liang ZY, Ning XB, Li WJ, Wang JP, Jin YL, Zhou N, and Li JF contributed to the study conception and design, and commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jin-Feng Li, MD, Department of Psychiatry, Hospital for Infectious Diseases, Dongfanghong Farm, Yuguopu Subdistrict, Mengzi City, Honghe Hani and Yi Autonomous Prefecture 661002, Yunnan Province, China. 17145353@qq.com
Received: September 2, 2025 Revised: December 16, 2025 Accepted: February 9, 2026 Published online: May 19, 2026 Processing time: 240 Days and 0.8 Hours
Abstract
BACKGROUND
Clozapine remains the gold therapeutic standard for treatment-resistant schizophrenia, and is associated with a range of adverse effects. Although autonomic dysregulation (e.g., psychosis and cholinergic rebound) during clozapine withdrawal is well documented, hypertension, as a withdrawal manifestation, has not yet been reported.
CASE SUMMARY
A 60-year-old man with treatment-resistant schizophrenia and metabolic syndrome developed refractory hypertension following sudden clozapine discontinuation. Despite escalating doses of antihypertensive medications, the patient’s blood pressure (BP) remained uncontrolled for 25 days. Secondary causes were excluded based on normal levels of aldosterone, cortisol, and adrenocorticotropic hormones. Hypertension resolved after reintroducing clozapine, titrated to 200 mg/day, and BP was stabilized at 115/74 mmHg during a 3-month follow-up.
CONCLUSION
Sudden clozapine withdrawal may precipitate severe hypertension in patients with metabolic syndrome, even in those receiving antihypertensive therapy. It is essential for clinicians to closely monitor BP during clozapine discontinuation, consider a gradual tapering protocol, and recognize the reintroduction of clozapine as a viable therapeutic option for managing withdrawal-associated hypertension.
Core Tip: This case is the first to describe severe, refractory hypertension as a consequence of sudden clozapine withdrawal in a patient with treatment-resistant schizophrenia and metabolic syndrome. Blood pressure remained uncontrolled despite intensive antihypertensive therapy, but normalized rapidly after clozapine reintroduction. These findings demonstrate that hypertension may be an unrecognized manifestation of clozapine withdrawal and highlight the critical importance of vigilant blood pressure monitoring, gradual tapering, and, when necessary, reintroduction of clozapine. This report contributes to the understanding of clozapine withdrawal syndromes and provides valuable clinical guidance for the safe management of affected patients.
