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Clozapine is used in combination with psychotropic medication and a wide variety of non-psychotropic medications. This article reviews the literature on clozapine drug interactions and the effect these have on serum level changes in clozapine. A total of 54 articles with a total of 109 individual case reports were obtained by manual and computerised literature search from January 1970 to May 2013. Psychotropic medications most likely to increase clozapine levels include: fluvoxamine, lamotrigine, aripiprazole and the discontinuation of levomepromazine and carbamazepine. Non-psychotropic medications associated with increase in clozapine levels include: erythromycin, ciprofloxacin, omeprazole, cimetidine, OCP containing ethinylestradiol, amiodarone, aluminum hydroxide and isoniazid. Rifampin and St John's wort resulted in low clozapine levels. Smoking cessation also increased clozapine levels. The role of routine clozapine monitoring in clinical practice requires further clarification. In the absence of recommendations for routine clozapine level monitoring, clinical judgment should always be used in addition to diagnostic testing. Clinicians must maintain increased clinical vigilance for adverse side effects when clozapine is combined with other medications.
Fibrous media in the form of nonwoven filters have been used extensively in water treatment as pre-filters or to support the medium that does the separation. Nonwoven media are composed of randomly oriented micron-size fibers and provide a one step separation as a substitute for conventional processes comprising chemical addition, flocculation, sedimentation, and sand filtration. At present the use of nonwoven filter media is limited to pre-filters and is not used further downstream as high performance filters. However it is expected that by reducing the fiber size in the nanometer range, higher filtration efficiency can be achieved. With the advent of nanotechnology, the ease of producing high quality nano scaled fibers is now a reality. Recent advancements in nanofibrous media through surface modifications have shown that nonwoven media can be used beyond the prefilter stage. Furthermore the pore size of the filter media can be controlled through modification of fiber size and thickness of membranes. These nanofibrous membranes possess high surface area and large porosity leading to high flux, low pressure membranes. This article highlights important opportunities and challenges associated with developing nanofibrous media for water treatment. In addition, we have attempted to capture a snapshot of this rapidly developing new area of fibrous media for water treatment for the benefit of the wider membrane community.
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