Abstract
The authors present a case report of a cocaine abuser who developed acute hepatitis and an extrapyramidal reaction after administration of clozapine, a novel dopamine antagonist. Previous clinical experience with clozapine is reviewed. Both clozapine and cocaine undergo hepatic metabolism, increasing the potential for hepatotoxicity in selected patients. The authors also review hepatic metabolism of biogenic amines, their central nervous system effects, and the pharmacologic effects of clozapine and other abused substances on bioamine metabolism. Substance abusers' high susceptibility to hepatotoxicity highlights the need for careful monitoring for this form of liver dysfunction when administering clozapine.