Anthony, 29, is under review at the Mental Health unit at the hospital. He’s in breach of a
disposition because of repeated alcohol and marijuana use.
Anthony is also diagnosed with bipolar disorder and is currently prescribed Clozapine 12.5
mg daily and lithium 800 mg daily. He experiences mania when he uses substances, and the
incident that led to his admission occurred when he was under the influence (he racked up
over $100,000 in property damages).
He uses substances and alcohol due to the negative side effects (weight gain, lethargy) from
his prescribed medications. Anthony is divorced and recently obtained regular visits with
his kids. He holds down a steady job in construction, but he’s worried about losing his
employment because he sometimes misses shifts.
Briefly explain the mechanism of action of Clozapine and how it might interact with alcohol
use.
The mechanism of action for Clozapine involves a combination of antagonist activity at the
dopamine D2 receptor and activity at various serotonin (5-HT) receptor subtypes, which results
in an antimanic effect with antidepressant type properties (Sealock & Seneviratne, 2025, p. 293).
Histamine H1 receptor antagonist activity provides sedating and appetite-stimulating effects
(Sealock & Seneviratne, 2025, p. 293). Additionally, alpha1-adrenergic receptor antagonist
activity is associated with orthostatic hypotension. Alcohol interacts with Clozapine by causing
severe central nervous system depression due to amplification of the drug's side effects as
mentioned. Essentially, the consumption of alcohol while on Clozapine can result in dizziness,
drowsiness, impaired judgement and reduced motor coordination.
Briefly explain the mechanism of action of Lithium and the effects that can make it difficult
for people to take the medication routinely.
Although the mood-stabilizing effect of Lithium is not fully understood, it is known to potentiate
serotonergic neurotransmission (Sealock & Seneviratne, 2025, p. 284). This is generally achieved
when Lithium ions work to alter sodium ion transport in nerve cells, which results in a shift of
catecholamine metabolism (Sealock & Seneviratne, 2025, p. 284). Lithium has a narrow
therapeutic range and requires blood level monitoring in order to prevent Lithium toxicity
(Sealock & Seneviratne, 2025, p. 284). A patient on Lithium also requires monitoring of their
serum sodium levels because both sodium and lithium are monovalent positive ions, and one can
affect the other (Sealock & Seneviratne, 2025, p. 284). Ultimately, this need for ongoing medical
monitoring makes it challenging for people to take the medication on a routine basis.
References
Sealock, K., Seneviratne, C., Lilley, L., Raniforth Collins, S., & Snyder, J.S. (2021). Lilly’s
Pharmacology for Canadian health care practice (4th Canadian ed.). Elsevier Canada. Chapter 17.
