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Kang N, Kim SH, Kim J, Kim S, Jang J, Yoon H, Lee J, Kim M, Kim YS, Kwon JS. Association between initial clozapine titration and pneumonia risk among patients with schizophrenia in a Korean tertiary hospital. Schizophr Res 2024; 268:107-113. [PMID: 37770376 DOI: 10.1016/j.schres.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
Pneumonia is a significant adverse drug reaction (ADR) associated with clozapine, characterized by high mortality and potential linkage with other inflammatory responses. Despite the critical nature, research regarding the development of pneumonia during initial clozapine titration remains limited. This retrospective study included 1408 Korean inpatients with schizophrenia spectrum disorders. Data were collected from January 2000 to January 2023. Pneumonia developed in 3.5 % of patients within 8 weeks of clozapine initiation. Patients who developed pneumonia were taking a greater number and higher dose of antipsychotics at baseline (2.14 vs. 1.58, p < 0.001; 25.64 vs. 19.34, p = 0.012). The average onset occurred 17.24 days after initiation, on an average dose of 151.28 mg/day. Titration was either paused or slowed in most of these patients, with no reported fatalities. The types of pneumonia included aspiration pneumonia, mycoplasma pneumonia, bronchopneumonia, and COVID-19 pneumonia. Myocarditis, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, and urinary tract infections were also identified. Logistic regression analysis revealed that a greater number of concomitant antipsychotics (odds ratio [OR] = 1.59, p = 0.027) and concomitant benzodiazepine use (OR = 2.33, p = 0.005) at baseline were associated with an increased risk of pneumonia. Overall, pneumonia development during clozapine titration is linked with other inflammatory ADRs, suggesting a shared immunological mechanism. Close monitoring is recommended, especially for patients taking multiple antipsychotics and benzodiazepines. Further studies involving repeated measures of clozapine concentrations at trough and steady state, along with a more detailed description of pneumonia types, are warranted.
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Affiliation(s)
- Nuree Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinhyeok Jang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesoo Yoon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeonghoon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
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El Ouni Amami N, Ali-Diabacte H, Ateb S, Ben Rejeb H, Bellis A, Bellis R, Januel D, Bouaziz N. Clozapine-induced cholinergic urticaria: a case report. Ther Adv Psychopharmacol 2024; 14:20451253241241056. [PMID: 38745850 PMCID: PMC11092545 DOI: 10.1177/20451253241241056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/31/2024] [Indexed: 05/16/2024] Open
Abstract
Clozapine, renowned for its efficacy in treatment-resistant schizophrenia, is associated with rare yet potentially severe side effects, including hematological disorders, myocarditis, seizures and gastrointestinal obstruction. Dermatological adverse effects, though less serious, can profoundly impact patients' quality of life. We present the first reported case of cholinergic urticaria induced by clozapine, in a 25-year-old male with treatment-resistant schizophrenia. Four months into clozapine therapy, the patient developed intensely pruritic erythematous lesions triggered by sweating, significantly impairing his daily activities. Despite attempts at management, including dose reduction and antihistamine therapy, the urticaria persisted. However, a favorable outcome was achieved upon switching to quetiapine. This case underscores the importance of recognizing and managing treatment-related adverse effects, even when they arise late in treatment, and highlights the need for individualized therapeutic approaches.We discuss potential mechanisms underlying clozapine-induced cholinergic urticaria and emphasize the significance of patient-centered care in optimizing treatment outcomes in schizophrenia.
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Affiliation(s)
| | | | - Sarra Ateb
- Établissement publique de santé mentale de Ville-Evrard, France
| | | | - Avicenne Bellis
- Établissement publique de santé mentale de Ville-Evrard, France
| | - Reza Bellis
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | | | - Noomane Bouaziz
- Établissement public de santé mentale de Ville Evrard, France
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Selvan P, Devkare P, Shetty A, Dharmadhikari S, Khandhedia C, Mane A, Mehta S, Andrade C. A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia. Front Psychiatry 2024; 15:1385925. [PMID: 38711874 PMCID: PMC11071166 DOI: 10.3389/fpsyt.2024.1385925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.
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Affiliation(s)
- Panneer Selvan
- Department of Psychiatry, Sneka Mind Care Hospital, Tirunelveli, Tamil Nadu, India
| | - Prashant Devkare
- Medical Affairs and Clinical Research, Sun Pharmaceutical Industries Limited, Mumbai, India
| | - Arthik Shetty
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Shruti Dharmadhikari
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chintan Khandhedia
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Amey Mane
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Suyog Mehta
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Hrichi H, Kouki N, Elkanzi NAA. Chromatographic Methods for the Analysis of the Antipsychotic Drug Clozapine and Its Major Metabolites: A Review. J Chromatogr Sci 2024:bmae016. [PMID: 38576210 DOI: 10.1093/chromsci/bmae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
Clozapine (CLZ), a second-generation antipsychotic, can effectively reduce schizophrenia, bipolar disorder and major depression symptoms. This review provides an overview of all reported chromatographic methods (62 references) for the quantification of CLZ and its two main metabolites, norclozapine and clozapine N-oxide in pharmaceutical formulations, biological matrices and environmental samples.
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Affiliation(s)
- Hajer Hrichi
- Chemistry Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
| | - Noura Kouki
- Department of Chemistry, College of Science, Qassim University, Buraidah 51452, Saudi Arabia
| | - Nadia Ali Ahmed Elkanzi
- Chemistry Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
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Berneri M, Jha U, O'Halloran S, Salman S, Wickramasinghe S, Kendrick K, Nguyen J, Joyce DA. Validation of Population Pharmacokinetic Models for Clozapine Dosage Prediction. Ther Drug Monit 2024; 46:217-226. [PMID: 38446630 DOI: 10.1097/ftd.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/03/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Clozapine is unique in its capacity to ameliorate severe schizophrenia but at high risk of toxicity. A relationship between blood concentration and clinical response and evidence for concentration-response relationships to some adverse effects justify therapeutic drug monitoring of clozapine. However, the relationship between drug dose and blood concentration is quite variable. This variability is, in part, due to inductive and inhibitory interactions varying the activity of cytochrome P450 1A2 (CYP1A2), the principal pathway for clozapine elimination. Several population pharmacokinetic models have been presented to facilitate dose selection and to identify poor adherence in individual patients. These models have faced little testing for validity in independent populations or even for persisting validity in the source population. METHODS Therefore, we collected a large population of clozapine-treated patients (127 patients, 1048 timed plasma concentrations) in whom dosing and covariate information could be obtained with high certainty. A population pharmacokinetic model was constructed with data collected in the first 6 weeks from study enrolment (448 plasma concentrations), to estimate covariate influences and to allow alignment with previously published models. The model was tested for its performance in predicting the concentrations observed at later time intervals up to 5 years. The predictive performances of 6 published clozapine population models were then assessed in the entire population. RESULTS The population pharmacokinetic model based on the first 6 weeks identified significant influences of sex, smoking, and cotreatment with fluvoxamine on clozapine clearance. The model built from the first 6 weeks had acceptable predictive performance in the same patient population up to the first 26 weeks using individual parameters, with a median predictive error (PE) of -0.1% to -15.9% and median absolute PE of 22.9%-27.1%. Predictive performance fell progressively with time after 26 weeks. Bayesian addition of plasma concentration observations within each prediction period improved individual predictions. Three additional observations extended acceptable predictive performance into the second 6 months of therapy. When the published models were tested with the entire data set, median PE ranged from -8% to +35% with a median absolute PE of >39% in all models. Thus, none of the tested models was successful in external validation. Bayesian addition of single patient observations improved individual predictions from all models but still without achieving acceptable performances. CONCLUSIONS We conclude that the relationship between covariates and blood clozapine concentrations differs between populations and that relationships are not stable over time within a population. Current population models for clozapine are not capturing influential covariates.
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Affiliation(s)
- Massimo Berneri
- Schools of Medicine & Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Uma Jha
- Schools of Medicine & Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Seán O'Halloran
- Clinical Pharmacology & Toxicology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Sam Salman
- Clinical Pharmacology & Toxicology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Kevin Kendrick
- Fremantle Hospital Mental Health Service, Fremantle, Western Australia, Australia
| | - Jessica Nguyen
- Department of Pharmacy, Graylands Hospital, Mount Claremont, Western Australia, Australia ; and
| | - David A Joyce
- Schools of Medicine & Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Clinical Pharmacology & Toxicology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Department of Clinical Pharmacology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Jamshidi Z, Roohbakhsh A, Karimi G. An overview on the protective effects of ellagic acid against heavy metals, drugs, and chemicals. Food Sci Nutr 2023; 11:7469-7484. [PMID: 38107104 PMCID: PMC10724599 DOI: 10.1002/fsn3.3704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 12/19/2023] Open
Abstract
Ellagic acid (EA) is a polyphenol extracted from many plants. EA modulates inflammatory mediators via antioxidant mechanisms, such as catalase (CAT) activities, superoxide dismutase (SOD), enhancement, increase in glutathione (GSH), and lipid peroxidation (LPO) suppression. EA has anti-apoptotic properties that are thought to be mediated by regulating the expression of B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and caspase-3. In this article, we surveyed the literature dealing with the protective effects of EA against different heavy metals, drugs, and natural toxins. The findings indicated that EA has remarkable protective properties against various toxicants. Its protective effects were mostly mediated via normalizing lipid metabolism, oxidative stress, and inflammatory mediators, for example, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-1β. The results of this study showed that EA has significant protective effects against a varied range of compounds, either chemical or natural. These effects are mainly mediated via intensifying the antioxidant defense system. However, other mechanisms such as inhibition of inflammatory responses and suppression of apoptosis are important.
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Affiliation(s)
- Zahra Jamshidi
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
- Department of Medicinal Chemistry, School of PharmacyMashhad University of Medical SciencesMashhadIran
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran
| | - Gholamreza Karimi
- Pharmaceutical Research Center, Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran
- Department of Pharmacodynamics and Toxicology, School of PharmacyMashhad University of Medical SciencesMashhadIran
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7
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Chandru P, Gunja N. Toxicity and Adverse Effects in Clozapine-Related Presentations to a Medical Toxicology Service in Western Sydney. J Med Toxicol 2023; 19:374-380. [PMID: 37624540 PMCID: PMC10522536 DOI: 10.1007/s13181-023-00963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Clozapine is an anti-psychotic agent, reserved for treatment-resistant schizophrenia, with demonstrated efficacy in an otherwise therapeutically challenging patient population. We aimed to review the full spectrum casemix of clozapine presentations to our tertiary toxicology service. METHODS In this retrospective study, we reviewed consecutive clozapine related toxicity presentations to a tertiary medical toxicology inpatient and consultation service-including deliberate self-poisoning (DSP), adverse drug reaction (ADR), recreational use, and therapeutic misadventure over a 10-year period from 2011 to 2021. Data were extracted for demographics, ingested dose, exposure characteristics, and patient outcome. RESULTS We identified 83 patients with clozapine-related presentations over the 10-year period. Twenty-two patients were excluded. Of the remaining 61 patients, 28 patients presented with DSP, 20 patients with accidental overdose, and 13 patients with an ADR; no patients presented with recreational use. It was noted that ADRs were largely idiosyncratic reactions and not always related to dose adjustments. In the context of therapeutic misadventure and DSP, we noted that a lower mean dose achieved a higher poison severity score (PSS) in clozapine-naive patients when compared to those patients on regular clozapine. CONCLUSIONS The presentation of clozapine-related toxicity differs depending on the modality of ingestion, whether DSP, accidental, or as a result of ADR. Patients naive to clozapine therapy tend to experience higher PSS with lower doses ingested either in a deliberate self-poisoning or accidental ingestion context. This is likely due to tolerance to the sedative properties of clozapine. No patients manifested clinical toxicity greater than 8 hours after ingestion, with an observation period of 6 hours accurately identifying toxicity in most patients.
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Affiliation(s)
- Pramod Chandru
- Department of Clinical Pharmacology & Toxicology, Western Sydney Health, Sydney, Australia.
| | - Naren Gunja
- Department of Clinical Pharmacology & Toxicology, Western Sydney Health, Sydney, Australia
- Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, New South Wales, Australia
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Bunting A, Silman D, Karia M, Johnson S. Clozapine and Sweet's syndrome: case report. BJPsych Open 2023; 9:e166. [PMID: 37665047 PMCID: PMC10486232 DOI: 10.1192/bjo.2023.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/20/2023] [Accepted: 06/06/2023] [Indexed: 09/05/2023] Open
Abstract
A patient developed fever, raised inflammatory markers and a maculopapular rash following commencement of clozapine for treatment of his schizoaffective disorder. Skin biopsy confirmed Sweet's syndrome. Identification of the cause was challenging, with a number of possible considerations including infection, malignancy and various potential drug triggers.This case highlights the difficulties in the diagnosis of Sweet's syndrome, as well as in identifying the original trigger, which can have significant consequences for management. Withdrawal of potentially causative drugs must be balanced with their benefits, and decisions must be made in the best interests of the patient. Following two courses of prednisolone and withdrawal of clozapine, the patient's rash and systemic symptoms resolved. This confirmed the diagnosis of drug-induced Sweet's syndrome, with clozapine as the offending agent. His mental state stabilised on an alternative antipsychotic.
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Affiliation(s)
- Apphia Bunting
- Oxford Health Foundation Trust, Warneford Hospital, Oxford, UK
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Das S, Itrat A, Hernandez MET, Subedi R, Jogarajah T, Vashist S, Daggala N. Clozapine-induced eosinophilia: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231195961. [PMID: 37667744 PMCID: PMC10475262 DOI: 10.1177/2050313x231195961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
Schizophrenia is a chronic neuropsychiatric illness defined by the appearance of positive, and negative symptoms and/or cognitive impairment. Antipsychotic drugs are predominantly used in the treatment of psychotic disorders, but not all patients with schizophrenia respond to every antipsychotic medication. Clozapine is one of the best atypical antipsychotics and is highly effective in treating treatment-resistant schizophrenia. Evidence suggests that clozapine appears to be effective in lowering the risk of suicide, extrapyramidal side effects, and relapse in patients with schizophrenia. Per contra, clozapine is not the first-line treatment due to its unalterable aftereffects such as agranulocytosis, metabolic syndrome, seizures, and rarely, eosinophilia. Eosinophilia can be life-threatening. Eosinophils infiltrate different tissues and cause inflammation in multiple organs causing end-organ damage. The current study aimed to report the incidence of eosinophilia associated with clozapine use in patients with schizophrenia. Literature on clozapine-induced eosinophilia is relatively scarce. Understanding the progression and management of clozapine-induced eosinophilia and its end-organ effects is imperative. While there is insufficient data about the guidelines in the management of clozapine-induced eosinophilia, this study contributes to understanding the patterns of the disease progression with clozapine dosage. A case study was done on a patient with schizophrenia and autistic spectrum disorder who was on clozapine. Data on how eosinophil levels varied with clozapine dosing was analyzed and documented. The evidence of clozapine dosage affecting eosinophil and C-reactive protein levels in this patient was summarized in a table and a narrative review.
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Affiliation(s)
- Soumitra Das
- Emergency Mental Health, Sunshine Hospital, Melbourne, VIC, Australia
| | - Annie Itrat
- Broadmeadows Inpatient Unit, Northern Health, Broadmeadows, VIC, Australia
| | | | - Rasish Subedi
- Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Thusanth Jogarajah
- Faculty of Medicine, Richmond Gabriel University, Belair, Saint Vincent and the Grenadines
| | | | - Nikitha Daggala
- Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
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Cai L, Chen G, Yang H, Bai Y. Efficacy and safety profiles of mood stabilizers and antipsychotics for bipolar depression: a systematic review. Int Clin Psychopharmacol 2023:00004850-990000000-00058. [PMID: 36947416 DOI: 10.1097/yic.0000000000000449] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The whole picture of psychotropics for bipolar depression (BPD) remains unclear. This review compares the differences in efficacy and safety profiles among common psychotropics for BPD. MEDLINE, EMBASE, and PsycINFO were searched for proper studies. The changes in the depressive rating scale, remission/response rates, nervous system adverse events (NSAEs), gastrointestinal adverse events (GIAEs), metabolic parameters, and prolactin were compared between medication and placebo or among medications with the Cohen's d or number needed to treat/harm. The search provided 10 psychotropics for comparison. Atypical antipsychotics (AAPs) were superior to lithium and lamotrigine at alleviating acute depressive symptoms. Lithium was more likely to induce dry mouth and nausea. Cariprazine and aripiprazole seemed to be associated with an increased risk of akathisia and upper GIAEs. Lurasidone was associated with an increased risk of developing akathisia and hyperprolactinemia. Olanzapine, olanzapine-fluoxetine combination (OFC), and quetiapine were associated with an increased risk of NSAEs, metabolic risk, dry mouth, and constipation. Cariprazine, lurasidone, OFC, or quetiapine was optimal monotherapy for BPD. Further studies are needed to assess the efficacy and safety of lamotrigine for treating BPD. Adverse events varied widely across different drug types due to variations in psychopharmacological mechanisms, dosages, titration, and ethnicities.
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Affiliation(s)
| | - Guanjie Chen
- Teaching Management Office, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
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Aguglia A, Parisi VM, Arduino G, Amerio A, Costanza A, Serafini G, Amore M. Clozapine in a Young Female with Drug-Resistant Schizophrenia: A Case Report of Development of Serositis. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:313-316. [PMID: 35331125 DOI: 10.2174/1871527321666220324121207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/29/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Clozapine may be considered the first-line option for treatment-resistant schizophrenia (TRS), a condition that occurs in more than 30% of patients with schizophrenia. Despite its efficacy for treating TRS, clozapine use is limited by the occurrence of several adverse effects in more than 70% of cases. Clozapine does not typically affect lung function, although a few cases have been reported in the literature. CASE PRESENTATION To gain a better understanding of this rare event, here we report the case study of a young female with TRS, who was treated with clozapine and developed medium and bilateral pleural effusion relief with contiguous atelectasis and polyserositis. Two weeks after stopping clozapine, the follow-up chest scan showed complete remission of the pulmonary condition. We postulate that clozapine might have caused, in this case, a specific immunoinflammatory response leading to serosal complications. CONCLUSION Although the underlying mechanisms of this adverse effect are not completely understood, early manifestations, such as benign eosinophilia, fever, and flu-like symptoms need to be considered a potential warning to facilitate an early diagnosis and carefully manage pulmonary complications related to clozapine treatment.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Maria Parisi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gabriele Arduino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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12
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Qubad M, Bittner RA. Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia. Ther Adv Psychopharmacol 2023; 13:20451253231158152. [PMID: 36994117 PMCID: PMC10041648 DOI: 10.1177/20451253231158152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine's wide-ranging superior efficacy - for treatment-resistant schizophrenia (TRS) and beyond - and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients' benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine's unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine's full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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13
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Clozapine is the approved option in treatment-resistant schizophrenia and requires careful management. DRUGS & THERAPY PERSPECTIVES 2023; 39:107-113. [PMID: 36811119 PMCID: PMC9936483 DOI: 10.1007/s40267-023-00982-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
Clozapine is the only agent approved for treatment-resistant schizophrenia, but is underprescribed. Its adverse drug event (ADE) profile and patient monitoring requirements can discourage its use, but the benefits of clozapine generally outweigh its risks, as most ADEs are manageable. Careful patient assessment, gradual titration, minimum effective dosages, therapeutic drug monitoring and checks of neutrophils, cardiac enzymes and ADE symptoms are recommended. Neutropenia is common but does not necessarily warrant permanent clozapine cessation.
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14
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Rhee D, Jones M, Mitchell KM, Segal J, Rice T, Coffey BJ. Clozapine and Constipation: Considerations in an Obese Adolescent Girl. J Child Adolesc Psychopharmacol 2022; 32:543-547. [PMID: 36548360 DOI: 10.1089/cap.2022.29231.bjc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Diane Rhee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Kate M Mitchell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
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15
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Antipsychotics and Medical Comorbidity: A Retrospective Study in an Urban Outpatient Psychiatry Clinic. Community Ment Health J 2022; 59:641-653. [PMID: 36355255 DOI: 10.1007/s10597-022-01045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
Patients with psychotic disorders have increased rates of medical comorbidities. In this cross-sectional study, we investigated the relationship between antipsychotics and medical comorbidities among patients with psychotic disorders in an urban psychiatry clinic in Atlanta, Georgia (n = 860). Each antipsychotic group was compared to a group of patients from the same sample who were not on any antipsychotic, and logistic regression models were constructed for each comorbidity. Ziprasidone was associated with diabetes (aOR 2.56, 95% CI 1.03-6.38) and obesity (aOR 3.19, 95% CI 1.37-7.41). Aripiprazole was associated with obesity (aOR 2.39, 95% CI 1.27-4.51). Clozapine was associated with GERD (aOR 3.59, 95% CI 1.11-11.61), movement disorders (aOR 4.44, 95% CI 1.02-19.32), and arrythmias (4.89, 95% CI 1.44-16.64). Two antipsychotics that are considered weight neutral, ziprasidone and aripiprazole, were associated with cardiometabolic comorbidities. This study suggests that research is warranted to study the association between antipsychotics, medical comorbidity, and psychotic symptom burden.
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16
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Jannini TB, Sansone A, Rossi R, Di Lorenzo G, Toscano M, Siracusano A, Jannini EA. Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment. Expert Opin Pharmacother 2022; 23:1065-1080. [PMID: 35470768 DOI: 10.1080/14656566.2022.2071124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION : First- and second-generation antipsychotics are highly accountable for causing a plethora of medical side effects, ranging from metabolic imbalances to sexual dysfunction (SD), that frequently undermine patient-doctor relationships. Nevertheless, to date antipsychotics are one of the best treatment options for dealing with numerous either acute or chronic conditions like agitation, suicidality, depression, dementia, and of course psychosis. For these reasons, clinicians need to handle them wisely to preserve patients' sexual health, avoid poor therapeutic adherence and prevent high rates of therapy drop-out. AREAS COVERED : This article reviews the literature on pharmacologic approaches for management strategies in men who are administered with antipsychotics and developed SD. The etiology of antipsychotic-induced SD is also discussed. EXPERT OPINION : Clinicians must consider sexual life as a major health domain. To do so, a first step would be to measure and monitor sexual function by means of psychometric tools. Secondly, primary prevention should be conducted when choosing antipsychotics, i.e., picking sex-sparing compounds like aripiprazole or brexpiprazole. Thirdly, if sexolytic compounds cannot be dismissed, such as first-generation antipsychotics, risperidone, paliperidone, or amisulpride, then aripiprazole 5-20 mg/day adjunctive therapy has proven to be most effective in normalizing prolactin levels and consequently treating antipsychotic-induced SD.
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Affiliation(s)
- Tommaso B Jannini
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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17
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Monroy-Jaramillo N, Martínez-Magaña JJ, Pérez-Aldana BE, Ortega-Vázquez A, Montalvo-Ortiz J, López-López M. The role of alcohol intake in the pharmacogenetics of treatment with clozapine. Pharmacogenomics 2022; 23:371-392. [PMID: 35311547 DOI: 10.2217/pgs-2022-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Clozapine (CLZ) is an atypical antipsychotic reserved for patients with refractory psychosis, but it is associated with a significant risk of severe adverse reactions (ADRs) that are potentiated with the concomitant use of alcohol. Additionally, pharmacogenetic studies have explored the influence of several genetic variants in CYP450, receptors and transporters involved in the interindividual response to CLZ. Herein, we systematically review the current multiomics knowledge behind the interaction between CLZ and alcohol intake, and how its concomitant use might modulate the pharmacogenetics. CYP1A2*1F, *1C and other alleles not yet discovered could support a precision medicine approach for better therapeutic effects and fewer CLZ ADRs. CLZ monitoring systems should be amended and include alcohol intake to protect patients from severe CLZ ADRs.
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Affiliation(s)
- Nancy Monroy-Jaramillo
- Department of Genetics, National Institute of Neurology & Neurosurgery, Manuel Velasco Suárez, La Fama, Tlalpan, Mexico City, 14269, Mexico
| | - José Jaime Martínez-Magaña
- Department of Psychiatry, Division of Human Genetics, Yale University School of Medicine, Orange, West Haven, CT 06477, USA
| | - Blanca Estela Pérez-Aldana
- Doctorado en Ciencias Biológicas y de la Salud, Metropolitan Autonomous University, Campus Xochimilco, Villa Quietud, Coyoacán, Mexico City, 04960, Mexico
| | - Alberto Ortega-Vázquez
- Metropolitan Autonomous University, Campus Xochimilco, Villa Quietud, Coyoacán, Mexico City, 04960, Mexico
| | - Janitza Montalvo-Ortiz
- Department of Psychiatry, Division of Human Genetics, Yale University School of Medicine, Orange, West Haven, CT 06477, USA
| | - Marisol López-López
- Metropolitan Autonomous University, Campus Xochimilco, Villa Quietud, Coyoacán, Mexico City, 04960, Mexico
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18
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John AP, Burrows S, Stanley S, Acabo C, Shymko G, Jaworska A, Velayudhan A. Demographic and clinical characteristics of patients who recommence clozapine following therapy interruptions. Acta Psychiatr Scand 2022; 145:293-300. [PMID: 34963015 DOI: 10.1111/acps.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The proportion of patients who recommence clozapine after cessation, the time taken to resume clozapine post-cessation, and distinguishing demographic and clinical characteristics of this group have been poorly researched. We evaluated these in the current study. METHOD We retrospectively extracted selected demographic and clinical variables and clozapine treatment interruption and recommencement data up to December 2018 of a cohort of 458 patients who first commenced clozapine between 2006 and 2016. The study was conducted at three Australian health services. RESULTS Of the 310 (69%) patients who had at least one interruption of clozapine treatment, 170 (54.8%) did not resume clozapine, and 140 (45.2%) recommenced it after the first interruption. More than half of those who recommenced did so within a month and 80% by 12 months. Cox regression analysis revealed that age was significantly associated with recommencement, with a 2% decrease in the likelihood of restarting after an interruption for each year later that clozapine was initially commenced (HR = 0.98 95%CI: 0.97, 0.997, p = 0.02). Those who ceased clozapine due to adverse effects were less likely to restart than those who ceased due to noncompliance (HR = 0.63 95%CI: 0.41, 0.97, p = 0.03). More time on clozapine prior to interruption increased the likelihood of restarting it, with each additional month on clozapine increasing this likelihood by 1% (HR = 1.01 95%CI: 1.01, 1.02, p < 0.001). CONCLUSION If the distinguishing demographic and clinical characteristics of the group identified in this study are corroborated through further research, this could further validate the need to identify treatment resistance and commence clozapine early in people with schizophrenia and provide appropriate interventions to those more at risk of permanent discontinuation of clozapine.
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Affiliation(s)
- Alexander Panickacheril John
- Bentley Health Service, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Sally Burrows
- University of Western Australia, Perth, Western Australia, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Susanne Stanley
- University of Western Australia, Perth, Western Australia, Australia
| | - Cherry Acabo
- Bentley Health Service, Perth, Western Australia, Australia
| | - Gordon Shymko
- Peel and Rockingham Kwinana Health Service, Cooloongup, South Australia, Australia
| | | | - Ajay Velayudhan
- Fremantle Hospital Health Service, Palmyra DC, Western Australia, Australia
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19
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Price GD, Heinz MV, Nemesure MD, McFadden J, Jacobson NC. Predicting symptom response and engagement in a digital intervention among individuals with schizophrenia and related psychoses. Front Psychiatry 2022; 13:807116. [PMID: 36032242 PMCID: PMC9403124 DOI: 10.3389/fpsyt.2022.807116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Despite existing work examining the effectiveness of smartphone digital interventions for schizophrenia at the group level, response to digital treatments is highly variable and requires more research to determine which persons are most likely to benefit from a digital intervention. MATERIALS AND METHODS The current work utilized data from an open trial of patients with psychosis (N = 38), primarily schizophrenia spectrum disorders, who were treated with a psychosocial intervention using a smartphone app over a one-month period. Using an ensemble of machine learning models, pre-intervention data, app use data, and semi-structured interview data were utilized to predict response to change in symptom scores, engagement patterns, and qualitative impressions of the app. RESULTS Machine learning models were capable of moderately (r = 0.32-0.39, R2 = 0.10-0.16, MAE norm = 0.13-0.29) predicting interaction and experience with the app, as well as changes in psychosis-related psychopathology. CONCLUSION The results suggest that individual smartphone digital intervention engagement is heterogeneous, and symptom-specific baseline data may be predictive of increased engagement and positive qualitative impressions of digital intervention in patients with psychosis. Taken together, interrogating individual response to and engagement with digital-based intervention with machine learning provides increased insight to otherwise ignored nuances of treatment response.
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Affiliation(s)
- George D Price
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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20
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Ma SM, Lim J, Jiang C, Luca L. Esophagitis after Clozapine Use in a 61-Year-Old Woman with Refractory Schizophrenia. Case Rep Psychiatry 2022; 2022:7033038. [PMID: 35693728 PMCID: PMC9187460 DOI: 10.1155/2022/7033038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Clozapine-induced esophagitis has been rarely reported. We herein report a case of a 61-year-old woman with schizophrenia who developed hematemesis, fever, and tachycardia after the initiation of clozapine. An esophagogastroduodenoscopy showed esophageal mucosal ulcerations. Her gastrointestinal symptoms resolved with pantoprazole, allowing continuation of her clozapine treatment. We report here an unusual association of severe esophagitis with clozapine use.
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Affiliation(s)
- Sung Min Ma
- 1Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA
| | - Junghyun Lim
- 2Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA
| | - Chunsu Jiang
- 3Division of Gastroenterology, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA
| | - Luminita Luca
- 1Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA
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21
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Pallares Vela E, Dave P, Cancarevic I. Clozapine-Related Thromboembolic Events. Cureus 2021; 13:e16883. [PMID: 34513458 PMCID: PMC8412001 DOI: 10.7759/cureus.16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 11/05/2022] Open
Abstract
Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. Venous thromboembolism (VTE) is a rare side effect of clozapine which can be fatal. This article summarizes current evidence regarding the risk of VTE associated with the use of clozapine. We performed a PubMed (MeSH) and Google Scholar search for the last two decades. Studies or case reports performed in humans were included in the review, of which 42 case reports of patients taking clozapine at VTE onset were included in the analysis of this review. According to the articles reviewed, the mean age was 42.9 years, with more males (71.43%) than females (28.57%). The average clozapine dose was 285.62 mg/day. VTE onset occurred within the first six months in 71.8% of the cases. Overall, 70.37% of the patients had comorbidities, and 87.5% had risk factors for VTE. In total, 68.57% were prescribed other medications at VTE onset, and 60% were being treated with another antipsychotic concomitantly. Finally, 32.5% of the patients died, while 67.5% survived. In 60% of the cases, clozapine was discontinued after VTE. In our literature review, we observed that among clozapine users, VTE occurred at a wide dose range, and most of the events occurred within the first six months. As many patients who are prescribed clozapine have risk factors for VTE, the risk should be considered at the time of prescribing. Further research should be conducted to elucidate the risk of VTE in clozapine users and the benefits of thromboprophylaxis.
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Affiliation(s)
- Elisa Pallares Vela
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prashil Dave
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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22
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Molden E. Therapeutic drug monitoring of clozapine in adults with schizophrenia: a review of challenges and strategies. Expert Opin Drug Metab Toxicol 2021; 17:1211-1221. [PMID: 34461790 DOI: 10.1080/17425255.2021.1974400] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Clozapine (CLZ) is the superior drug in treatment of schizophrenia. Serum concentration of CLZ is associated with clinical response and dose-dependents side effects, where generalized tonic-clonic seizures are most critical. Thus, therapeutic drug monitoring (TDM) of CLZ may guide individual dosing to reach target exposure and prevent dose-dependent side effects. However, current TDM methods are not capable of predicting the risk of agranulocytosis, which is a dose-independent side effect restricting use of CLZ to treatment-resistant schizophrenia (TRS). AREAS COVERED The article provides an overview of clinical, pharmacological, and toxicological aspects of CLZ, and the role of TDM as a tool for dose titration and follow-up in patients with TRS. Main focus is on current challenges and strategies in CLZ TDM, including future perspectives on potential identification/analysis of CLZ metabolite biomarkers reflecting the risk of granulocyte toxicity. EXPERT OPINION The association between CLZ serum concentration, clinical response and risk of seizures is indisputable. TDM should therefore always guide CLZ dose titration. Development of advanced TDM methods, including biomarkers predicting the risk of granulocyte toxicity might extend TDM to be a tool for deciding which patients that can be treated safely with CLZ, potentially increasing its utility beyond TRS.
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Affiliation(s)
- Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
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23
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Ramzan A, Aggarwal R, Jamal F. Novel case of Parkinson's disease and schizophrenia: challenges in the management. BMJ Case Rep 2021; 14:14/7/e244028. [PMID: 34326119 PMCID: PMC8323365 DOI: 10.1136/bcr-2021-244028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Coexistence of idiopathic Parkinson's disease (iPD) and schizophrenia can pose great diagnostic and therapeutic challenges because of their pathophysiology. Our case highlights such challenges in management. We present a case of 73-year-old man who had parkinsonism for last several years and was also diagnosed with schizophrenia. Due to lack of collateral information about the onset of symptoms and clinical course, it was difficult to distinguish iPD from neuroleptic-induced parkinsonism. Even though, certain clinical findings may help to differentiate between the two conditions, single positron emission computerized tomography/DatScan was used to confirm the diagnosis of iPD. Treatment of coexisting iPD and schizophrenia can be challenging, and a delicate pharmacologic balance must be maintained to ensure adequate symptomatic control. Current evidence suggests that clozapine is a better choice for managing psychosis in these patients due to its unique receptor profile and better safety data.
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Affiliation(s)
- Amna Ramzan
- Department of Neurology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Ruchi Aggarwal
- Department of Psychiatry, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Fariha Jamal
- Department of Neurology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
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24
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de Filippis R, Gaetano R, Schoretsanitis G, Verde G, Oliveti CA, Kane JM, Segura-Garcia C, De Fazio P. Clozapine Management in Schizophrenia Inpatients: A 5-Year Prospective Observational Study of Its Safety and Tolerability Profile. Neuropsychiatr Dis Treat 2021; 17:2141-2150. [PMID: 34234440 PMCID: PMC8257059 DOI: 10.2147/ndt.s312095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clozapine is well known for its efficacy and clinical superiority compared to other antipsychotics in treatment-resistant schizophrenia (TRS). However, it is frequently underutilized worldwide because of its acute adverse events, as well as for its long-term cardiometabolic and hematological consequences. OBJECTIVE The aim of the study was to evaluate 5-year safety in chronic TRS inpatients with continuous clozapine use. METHODS Patients with TRS and clozapine treatment were evaluated for 5 years. All participants were assessed using the Brief Psychiatric Rating Scale (BPRS), Glasgow Antipsychotic Side-effect Scale for Clozapine (GASS-C), Social Performance Scale (PSP) and Short Portable Mental Status Questionnaire (SPMSQ). Clinical, cardiometabolic and hematological data were collected periodically. General linear models (GLM) repeated measures controlling for CLZ dose were utilized to determine differences in variables across the time. RESULTS Overall, 189 inpatients were screened for study participation. The final sample included twenty-one TRS patients (16 males, 76%) with an average age of 57.6 years, all with 5-year continuous use of clozapine (mean dose 266 mg/day). There was not a significant effect of time on BPRS (p=0.774), PSP (p=0.855) and SPMSQ (p=0.066); differences remained not significant after controlling for CLZ dose (p=0.585, p=0.467 and p=0.105, respectively). No changes were found in blood and clinical parameters except for red blood cell count, which decreased over time (p=0.024; η2= 0.952). Patients reported a significant BMI decrease (-8.98 kg, p=0.008) between baseline and 5 years last observation. CONCLUSION The findings show how the application of a structured dietary, clinical and therapeutic monitoring program in psychiatric care facilities could allow the safe and effective long-term cardiometabolic and hematological management of clozapine. The unique role that clozapine plays in the current treatment of patients with TRS requires greater clinical awareness. Although its acute and chronic side effects are notorious, its safety management is feasible and broadens its potential practical application.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Verde
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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25
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Willcocks IR, Legge SE, Nalmpanti M, Mazzeo L, King A, Jansen J, Helthuis M, Owen MJ, O’Donovan MC, Walters JTR, Pardiñas AF. Clozapine Metabolism is Associated With Absolute Neutrophil Count in Individuals With Treatment-Resistant Schizophrenia. Front Pharmacol 2021; 12:658734. [PMID: 33959025 PMCID: PMC8094024 DOI: 10.3389/fphar.2021.658734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Up to one-third of those with schizophrenia fail to respond to standard antipsychotics and are considered to have treatment-resistant schizophrenia, a condition for which clozapine is the only evidence-based medication. While up to 60% of treated individuals obtain therapeutic benefits from clozapine, it is currently underprescribed worldwide, partly because of concerns related to its broad adverse effect profile. In particular, the potential effects of clozapine on the immune system have gained relevance after a recent study showed that drug plasma concentrations were inversely correlated with neutrophil counts in individuals routinely undergoing treatment. Seeking to investigate this relationship in more detail, we extracted metabolic, immune, and genetic data from a UK cohort of long-term clozapine users linked to a clozapine monitoring service, CLOZUK2 (N = 208). Whilst a correlation analysis was compatible with the original results, a multiple linear regression accounting for dose and other confounding factors additionally allowed us to estimate the decrease in absolute neutrophil counts to approximately 141 cells/mm3 for every 0.1 mg/L increase in clozapine concentration. However, this association was attenuated after controlling for the metabolic ratio between clozapine and its main metabolite, norclozapine, which was itself negatively associated with neutrophil concentrations. Further analyses revealed that these relationships are likely moderated by genetic factors, as three pharmacogenomic SNPs previously associated to norclozapine plasma concentrations and the metabolic ratio (rs61750900, rs2011425 and rs1126545) were shown to be independently associated with a variation in neutrophil counts of about 400 cells/mm3 per effect allele. Such results are compatible with an effect of norclozapine, but not necessarily clozapine, on immune cell counts, and highlight the need for further investigations into the potential role of genetic determinants of clozapine pharmacokinetics in the occurrence of adverse effects during treatment.
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Affiliation(s)
- Isabella R. Willcocks
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Sophie E. Legge
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Mariana Nalmpanti
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Lucy Mazzeo
- Hafan y Coed Mental Health Unit, University Hospital of Llandough, Cardiff, United Kingdom
| | - Adrian King
- Magna Laboratories Ltd., Ross-on-Wye, United Kingdom
| | | | | | - Michael J. Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Michael C. O’Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - James T. R. Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Antonio F. Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Ortega-Vázquez A, Mayen-Lobo YG, Dávila-Ortiz de Montellano DJ, Tristán-López L, Aviña-Cervantes CL, Ríos C, López-López M, Monroy-Jaramillo N. Alcohol intake potentiates clozapine adverse effects associated to CYP1A2*1C in patients with refractory psychosis. Drug Dev Res 2020; 82:685-694. [PMID: 33336447 DOI: 10.1002/ddr.21774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022]
Abstract
Clozapine (CLZ) is an atypical antipsychotic and the gold standard for refractory psychosis treatment. However, there is little information regarding pharmacogenetics of CLZ in patients with refractory psychosis and its clinical correlation with alcohol intake. Although neurological effects of CLZ in patients with concomitant alcohol intake are documented, its use is very common in patients with psychosis. We explored the impact of CYP1A2, CYP2D6, CYP2C19, and CYP3A4 genetic variants on CLZ pharmacokinetics and side effects, along with coffee/alcohol/tobacco consumption habits and clinical data of 48 adult patients with refractory psychosis on CLZ antipsychotic monotherapy. Relevant CYP variants in CLZ metabolism were evaluated by targeted genotyping and multiplex ligation-dependent probe amplification. CLZ and its main metabolite plasma concentrations were determined by high performance liquid chromatography. Biochemical and molecular data, along with other potential confounders, were included in the analysis by linear regression. Overall, CYP variants showed no effect on CLZ pharmacokinetics. The rs2069514 variant in homozygous genotype (also known as CYP1A2*1C/*1C) was associated with CLZ adverse reactions in Mexican patients with refractory psychosis (OR = 3.55 CI95 = 1.041-12.269, p = .043) and demonstrated that this effect is doubled by concomitant alcohol consumption (OR = 7.9 CI95 = 1.473-42.369, p = .016). Clinicians should be aware of this information before starting CLZ use, when treating patients with refractory psychosis, who are alcohol drinkers and carriers of this genetic variant in order to prevent CLZ-related adverse reactions. Nevertheless, our findings should be replicated in larger samples.
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Affiliation(s)
- Alberto Ortega-Vázquez
- Department of Biological Systems, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico
| | - Yerye G Mayen-Lobo
- Department of Biological Systems, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico.,Master's Program in Pharmaceutical Sciences, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico
| | | | - Luis Tristán-López
- Department of Neurochemistry, National Institute of Neurology and Neurosurgery, "Manuel Velasco Suárez", Mexico City, Mexico
| | - Carlos L Aviña-Cervantes
- Department of Psychiatry, National Institute of Neurology and Neurosurgery, "Manuel Velasco Suárez", Mexico City, Mexico
| | - Camilo Ríos
- Department of Biological Systems, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico.,Master's Program in Pharmaceutical Sciences, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico.,Department of Neurochemistry, National Institute of Neurology and Neurosurgery, "Manuel Velasco Suárez", Mexico City, Mexico
| | - Marisol López-López
- Department of Biological Systems, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico
| | - Nancy Monroy-Jaramillo
- Department of Genetics, National Institute of Neurology and Neurosurgery, "Manuel Velasco Suárez", Mexico City, Mexico
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Iqbal E, Govind R, Romero A, Dzahini O, Broadbent M, Stewart R, Smith T, Kim CH, Werbeloff N, MacCabe JH, Dobson RJB, Ibrahim ZM. The side effect profile of Clozapine in real world data of three large mental health hospitals. PLoS One 2020; 15:e0243437. [PMID: 33290433 PMCID: PMC7723266 DOI: 10.1371/journal.pone.0243437] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 11/22/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Mining the data contained within Electronic Health Records (EHRs) can potentially generate a greater understanding of medication effects in the real world, complementing what we know from Randomised control trials (RCTs). We Propose a text mining approach to detect adverse events and medication episodes from the clinical text to enhance our understanding of adverse effects related to Clozapine, the most effective antipsychotic drug for the management of treatment-resistant schizophrenia, but underutilised due to concerns over its side effects. MATERIAL AND METHODS We used data from de-identified EHRs of three mental health trusts in the UK (>50 million documents, over 500,000 patients, 2835 of which were prescribed Clozapine). We explored the prevalence of 33 adverse effects by age, gender, ethnicity, smoking status and admission type three months before and after the patients started Clozapine treatment. Where possible, we compared the prevalence of adverse effects with those reported in the Side Effects Resource (SIDER). RESULTS Sedation, fatigue, agitation, dizziness, hypersalivation, weight gain, tachycardia, headache, constipation and confusion were amongst the highest recorded Clozapine adverse effect in the three months following the start of treatment. Higher percentages of all adverse effects were found in the first month of Clozapine therapy. Using a significance level of (p< 0.05) our chi-square tests show a significant association between most of the ADRs and smoking status and hospital admission, and some in gender, ethnicity and age groups in all trusts hospitals. Later we combined the data from the three trusts hospitals to estimate the average effect of ADRs in each monthly interval. In gender and ethnicity, the results show significant association in 7 out of 33 ADRs, smoking status shows significant association in 21 out of 33 ADRs and hospital admission shows the significant association in 30 out of 33 ADRs. CONCLUSION A better understanding of how drugs work in the real world can complement clinical trials.
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Affiliation(s)
- Ehtesham Iqbal
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Risha Govind
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Alvin Romero
- SLAM BioResource for Mental Health, South London and Maudsley NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Olubanke Dzahini
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matthew Broadbent
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
| | - Robert Stewart
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Chi-Hun Kim
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Nomi Werbeloff
- UCL Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington, NHS Foundation Trust, London, United Kingdom
| | - James H. MacCabe
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
| | - Richard J. B. Dobson
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
- The Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Zina M. Ibrahim
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
- The Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
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An Open-Label, Head to Head Comparison Study between Prucalopride and Lactulose for Clozapine Induced Constipation in Patients with Treatment Resistant Schizophrenia. Healthcare (Basel) 2020; 8:healthcare8040533. [PMID: 33287162 PMCID: PMC7761681 DOI: 10.3390/healthcare8040533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 01/15/2023] Open
Abstract
Clozapine remains as the gold standard for the management of treatment resistant schizophrenia. Nevertheless, mortality and morbidity associated with Clozapine is partly contributed by its adverse effect of constipation in view of its prominent anticholinergic properties. Despite the evidence that approximately 60% of patients on Clozapine will experience constipation, there is no proper guideline as to the best laxative in the treatment of Clozapine induced constipation. Hence this study was conducted to evaluate the efficacy and safety of Prucalopride and Lactulose in the treatment of Clozapine induced constipation. This was a four week, prospective, open-label head to head comparison study between Prucalopride and Lactulose in the treatment of Clozapine induced constipation. Male and female patients on Clozapine between the age of 18–60 with an established diagnosis of treatment resistant schizophrenia with ≤2 spontaneous complete bowel movement per week were recruited in this study. Eligible patients were assigned into two groups. Patients received Prucalopride 2 mg once daily or Lactulose 10 g once daily for four weeks. Efficacy was analyzed in 58 patients. The proportion of patient with ≥3 spontaneous complete bowel movement (SCBM) was higher in the Prucalopride 2 mg group, reaching significance at Week 4 with p-value of (p = 0.029). The proportion of patient with ≥3 SCBM at Week 1 was 71.4% in the Prucalopride 2 mg group and 60% in the Lactulose 10 g group. The proportion of patient with ≥3 SCBM at Week 4 was 85.7% in the Prucalopride 2 mg group and the proportion remained at 60% in the Lactulose 10 g group. The improvement in the dissatisfaction and treatment satisfaction subscales of the patient assessment of constipation—quality of life (PAC-QOL) were higher in the Prucalopride 2 mg group compared to the Lactulose 10 g group. The common adverse events associated with Prucalopride 2 mg were abdominal pain and loose stools which was transient and subsided within a few days. Over four weeks, in this population of patients with Clozapine induced constipation, Prucalopride 2 mg significantly improved the bowel movement and it was safe.
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Edinoff A, Wu N, deBoisblanc C, Feltner CO, Norder M, Tzoneva V, Kaye AM, Cornett EM, Kaye AD, Viswanath O, Urits I. Lumateperone for the Treatment of Schizophrenia. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:32-59. [PMID: 33012872 PMCID: PMC7511146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction Schizophrenia is a severe psychotic disorder that is diagnosed by the presence of hallucinations or delusions along with disorganized speech, disorganized thought, or negative symptoms that are present for at least six months. Roughly 1 in 10,000 people a year are diagnosed with this psychiatric disorder. It is a chronic disorder requiring a lifetime of treatment of which antipsychotics have been the mainstay of this treatment. First-generation antipsychotics have dystonia, parkinsonism, and development of Tardive Dyskinesia as major side effects, and they are also nonspecific in terms of their actions. Second Generation antipsychotics target more specific dopamine and sometimes serotonin receptors with less dystonic side effects; however, there are additional concerns for the development of metabolic syndrome. This review aims to look at new medication on the market, lumateperone, for the treatment of Schizophrenia. Recent studies In one four week study with 60mg and 120mg of Lumateperone compared, 4mg of Risperdal, and a placebo found that Lumateperone significantly decreased the total Positive and Negative Syndrome Scale (PANSS) from baseline. Safety analysis of this study also found that Lumateperone was not associated with EPS or significant weight gain. Another study found that 42mg of Lumateperone significantly decreased PANSS score over placebo and 28mg of Lumateperone with associated TEAEs of somnolence, sedation, fatigue, and constipation. In an open-label safety, patients were switched from their current antipsychotic to Lumateperone and then switched back to their previous treatment after six weeks. PATIENTS were found to have statistically significant improvements in metabolic parameters, weight, and endocrine parameters, which were all lost when they were switched back to their previous treatment and their schizophrenic symptoms at pre-trial levels or improved them while on Lumateperone. In a continuation of the previous study over 12 months, 4 TEAEs occurred in 5% or more of the participants: diarrhea, dry mouth, weight decrease, and headache. Prolactin, metabolic labs, BMI, and weight all decreased as compared to the standard of care. Pooled studies revealed EPS related TEAEs were less frequent in patients receiving 42 mg lumateperone over Risperdal. Another pooled study looked at the safety profile; they found patients treated with lumateperone, two TEAEs occurred at twice the placebo rate and at a rate of 5% or more: dry mouth (5% vs. 2.2%) and sedation (24.1% vs. 10.0%) though TEAE discontinuation rates were lower than with Risperdal. Summary Taken together, data from these trials suggest that lumateperone can effectively treat positive symptoms, negative symptoms, and cognitive dysfunction in schizophrenia. Lumateperone entrance to the market introduces an innovative way to treat schizophrenia featuring both a novel mechanism of action and a markedly reduced side effect profile. Further research is needed to determine the efficacy of Lumateperone in treating bipolar disorder in addition to schizophrenia.
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Affiliation(s)
- Amber Edinoff
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Natalie Wu
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Charles deBoisblanc
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Catherine Olivia Feltner
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Mariah Norder
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Vesela Tzoneva
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Adam M Kaye
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Elyse M Cornett
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Alan D Kaye
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Omar Viswanath
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Ivan Urits
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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Baykara S, Gündoğan Bozdağ P, Baykara M, Namlı MN. Evaluation of arterial stiffness in patients with schizophrenia. J Clin Neurosci 2020; 79:149-153. [PMID: 33070886 DOI: 10.1016/j.jocn.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate arterial stiffness in schizophrenia patients. 28 male patients were included. The intima-media thickness (IMT) of the vessels were taken using high-resolution ultrasonography system. The mean carotid IMT and the mean femoral IMT values of the study group were found to be statistically significantly higher than the values of the control group. As the duration of the disease increased, there was an increase in the carotid IMT, carotid elastic modulus and femoral IMT, whereas there was a decrease in carotid and femoral diastolic wall stress in patients. No statistically significant differences were observed between the groups' carotid and femoral compliance, distensibility and elastic modulus values. The mean systolic arterial blood pressure in the patient group was determined to be lower than that of the control group. The mean diastolic wall stress values in the carotid and femoral arteries were determined to be lower than those of the control group. There was no relationship between antipsychotic dose, blood pressure and arterial stiffness parameters. Schizophrenia patients are more prone to develop arterial stiffness by atherosclerosis either with the effect of the nature of the disease itself or antipsychotic treatment. But evaluation with more parameters (carotid and femoral compliance, distensibility and elastic modulus) did not indicate any difference from the control group in respect of arterial stiffness. Antipsychotic treatment may play a protective role in terms of arterial stiffness by causing a decrease in systolic arterial pressure and carotid and femoral diastolic wall stress.
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Affiliation(s)
- Sema Baykara
- Fırat University, Faculty of Medicine, Department of Psychiatry, Elazig, Turkey.
| | | | - Murat Baykara
- Fırat University, Faculty of Medicine, Department of Radiology, Elazig, Turkey
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de Filippis R, Soldevila-Matías P, De Fazio P, Guinart D, Fuentes-Durá I, Rubio JM, Kane JM, Schoretsanitis G. Clozapine-related drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a systematic review. Expert Rev Clin Pharmacol 2020; 13:875-883. [PMID: 32576056 DOI: 10.1080/17512433.2020.1787831] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe, multiorganic, and potentially life-threatening drug-induced hypersensitivity reaction, linked to several common drugs, including antiepileptics, antibiotics, and several psychotropic drugs, including clozapine. Due to the importance of clozapine in the management of treatment-resistant schizophrenia, a systematic review and characterization of clozapine-related DRESS syndrome is long overdue. AREAS COVERED This systematic review was conducted following PRISMA guidelines. PubMed, Embase, PsychINFO, and the Cochrane Library databases were independently reviewed up to 1 November 2019 for articles reporting clozapine-related DRESS syndrome cases. The RegiSCAR score system was applied to systematically characterize the clinical presentations of selected studies. EXPERT OPINION Clozapine-related DRESS syndrome was reported in six patients from four articles. Five patients received polypharmacy. Skin rash and liver involvement with elevated liver enzymes were very common. No fatal cases were found. Treatment mainly included clozapine discontinuation and immunosuppression. The mismatch between incidences of DRESS with other responsible drugs, the common misdiagnosis of this syndrome, and the fact that an extensive literature search only identified six cases suggests that clozapine-related DRESS may be overlooked. It is, therefore, necessary to optimize diagnostic strategies to identify immune-related side effects of clozapine.
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Affiliation(s)
- Renato de Filippis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health , Glen Oaks, NY, USA.,Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro , Catanzaro, Italy
| | - Pau Soldevila-Matías
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health , Glen Oaks, NY, USA.,Research Institute of Clinic University Hospital of Valencia (INCLIVA) , Valencia, Spain
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro , Catanzaro, Italy
| | - Daniel Guinart
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health , Glen Oaks, NY, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra , Hempstead, NY, USA
| | - Inmaculada Fuentes-Durá
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Valencia , Valencia, Spain
| | - Jose M Rubio
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health , Glen Oaks, NY, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra , Hempstead, NY, USA.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research , Manhasset, NY, USA
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health , Glen Oaks, NY, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra , Hempstead, NY, USA.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research , Manhasset, NY, USA
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Suvarna P, Kayarkatte MN, Shenoi SD, Jaiprakash P. A rare case of clozapine-induced symmetrical drug-related intertriginous and flexural exanthema with vasculitis-like lesions. Contact Dermatitis 2020; 82:318-320. [PMID: 31922262 DOI: 10.1111/cod.13468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Punya Suvarna
- Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal; Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Manasa N Kayarkatte
- Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal; Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Shrutakirthi D Shenoi
- Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal; Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Padmapriya Jaiprakash
- Department of Pathology, Venereology and Leprosy, Kasturba Medical College, Manipal; Manipal Academy of Higher Education (MAHE), Manipal, India
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Do Asian and North American patients with bipolar disorder have similar efficacy, tolerability, and safety profile during clinical trials with atypical antipsychotics? J Affect Disord 2020; 261:259-270. [PMID: 31669925 DOI: 10.1016/j.jad.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The approvals of psychotropics for bipolar disorder (BD) are mainly based on randomized, double-blind, placebo-controlled trials (RCTs) from North America. It remains unknown whether approved psychotropics have similar efficacy, tolerability, and safety for Asians with BD. The aim of this systematic review was to compare those differences of psychotropics between Asians and North Americans with BD. METHODS MEDLINE, EMBASE, and PsycINFO were searched for RCTs studied in two regions. The effect size, remission/response rate, and risk for discontinuation due to adverse events (AEs), weight gain (WG), nervous systems and gastrointestinal AEs were assessed and compared between two regions with Cohen's d or number needed to treat/harm. RESULTS Eleven studies of aripiprazole, olanzapine, risperidone, and quetiapine in BD were included. Similar efficacy and relatively benign tolerability of atypical antipsychotics (AAPs) between Asians and Americans with BD were observed in most studies. The risk for AAP-related WG was similar between two regions. Asians with mania or bipolar depression were more vulnerable to akathisia/tremor or constipation. Japanese and Chinese with bipolar depression were more sensitive to somnolence and dizziness, respectively. Americans were more likely to have dry mouth, nausea, and vomiting. LIMITATIONS The number of included psychotropics and papers was small. CONCLUSIONS Differences in AAP-related efficacy and tolerability were minimal between the two regions, but some AEs appeared to be different. Clinicians should pay attention to these differences to optimize treatment strategies in different races/ethnicities with BD.
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Nagendrappa S, Sreeraj VS, Venkatasubramanian G. "I Stopped Hearing Voices, Started to Stutter" - A Case of Clozapine-Induced Stuttering. Indian J Psychol Med 2019; 41:97-98. [PMID: 30783319 PMCID: PMC6337922 DOI: 10.4103/ijpsym.ijpsym_157_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sachin Nagendrappa
- InSTAR Program, Schizophrenia and Metabolic Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vanteemar S Sreeraj
- InSTAR Program, Schizophrenia and Metabolic Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- InSTAR Program, Schizophrenia and Metabolic Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Vodusek Z, Feuerstadt P, Brandt LJ. Review article: the pharmacological causes of colon ischaemia. Aliment Pharmacol Ther 2019; 49:51-63. [PMID: 30467871 DOI: 10.1111/apt.15052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/05/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colon ischaemia is the most common ischaemic disorder of the gastrointestinal system, can affect any segment of the colon, and may present with a range of symptoms. Diagnosis can be challenging due to symptom overlap with other conditions, varied aetiology, and often rapid and self-resolving course. AIM To review comprehensively the literature regarding the pharmacological aetiologies of colonic ischaemia to enhance the understanding of the various mechanisms of disease, presentations, distribution, and outcomes. METHODS A PubMed search for "colon ischaemia" and "ischaemic colitis" alone as well as in combination with various known pharmacologic causes was performed. Only the highest quality and relevant literature was included in this review. The quality of the literature for each association was rated by the authors and a consensus was made when discrepancies were encountered. Only associations that were deemed "moderate" or "strong" were included. RESULTS The literature considering pharmacologically associated colonic ischaemia is diverse, lacks codification and is characterised by numerous case reports and case series. Constipation-inducing drugs, digoxin, hormonal therapies, illicit drugs, immunomodulators, laxatives, and NSAIDs were strongly associated with colonic ischaemia. Antimicrobials, appetite suppressants, chemotherapies, decongestants, diuretics, ergot alkaloids, serotonin agents, statins, and vasopressor agents were moderately associated. CONCLUSIONS Patients presenting with abdominal pain, diarrhoea, or bloody stool need to be evaluated for the possibility of this condition and treated accordingly. Timely diagnosis is necessary to improve patient outcomes. This review aims to increase awareness among clinicians regarding the presentation of pharmacologically induced colonic ischaemia.
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Affiliation(s)
- Ziga Vodusek
- Frank H. Netter, MD. School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Paul Feuerstadt
- Gastroenterology Center of Connecticut, Yale University School of Medicine, Hamden, Connecticut
| | - Lawrence J Brandt
- Division of Gastroenterology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Nocturnal Enuresis is an Under-recognised Side Effect of Clozapine: Results of a Systematic Review. ACTA ACUST UNITED AC 2018. [DOI: 10.2478/gp-2018-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Objectives
Clozapine is an effective antipsychotic medication licenced for the management of treatment resistant schizophrenia. Due to its non-selective pharmacology, it has a broad range of side effects. Nocturnal enuresis secondary to the use of clozapine has been documented in the literature but may be overlooked, the link between drug and symptom being clinically unnoticed. Patients may not mention urinary symptoms due to supervening psychosis, co-existing symptomatology, embarrassment or shame. By raising awareness of the phenomenon, early recognition and patient support may improve compliance with clozapine medication, and consecutively, overall mental health. Consequently, this systematic review investigates the prevalence of nocturnal enuresis secondary to clozapine use.
Methods
A literature search on clozapine and nocturnal enuresis was used to identify the relevant papers. Papers providing the prevalence data on Clozapine associated nocturnal enuresis were selected for data extraction.
Results
47 papers were initially identified. Eight papers focused on the prevalence of clozapine associated nocturnal enuresis (CANE). Point prevalence (nocturnal enuresis at the time of assessment), 1-month prevalence and episode prevalence (nocturnal enuresis since beginning of clozapine) were given. Papers included patients with schizophrenia, schizoaffective disorder, bipolar affective disorder and psychotic depression, taking clozapine medication. The prevalence of CANE ranged from 10–42%. Point prevalence was 21–27%, 1-month prevalence was 10–39% and episode prevalence was 15–42%. Clozapine was more likely to cause nocturnal enuresis compared to other psychotropic medication.
Conclusion
The prevalence of CANE may be greater than previously thought. However, in order to determine an accurate prevalence of clozapine associated nocturnal enuresis, larger studies with strict inclusion criteria, common definition of diagnosis and prevalence are required. By establishing an accurate prevalence, physician awareness can be improved, and patients can becounselled on the risk of developing the side effect, thus improving early identification and reducing discontinuation rates.
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John AP, Ko EKF, Dominic A. Delayed Initiation of Clozapine Continues to Be a Substantial Clinical Concern. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:526-531. [PMID: 29682998 PMCID: PMC6099752 DOI: 10.1177/0706743718772522] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Arun Dominic
- 3 Rockingham General Hospital, Perth, WA, Australia
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Gonsai NH, Amin VH, Mendpara CG, Speth R, Hale GM. Effects of dopamine receptor antagonist antipsychotic therapy on blood pressure. J Clin Pharm Ther 2017; 43:1-7. [PMID: 29119585 DOI: 10.1111/jcpt.12649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/22/2017] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hypertension, a major risk factor for adverse cardiovascular events, such as stroke and myocardial infarction, affects 80 million American adults. The aetiology of hypertension is multifaceted and difficult to identify. Dopamine receptors, especially those in the kidneys, play a role in blood pressure regulation, and alterations in their function can cause hypertension. The objective of this review was to investigate the association between the use of dopamine antagonists with hypertension focusing especially on second-generation antipsychotics, like clozapine that is D4 receptor antagonist. METHODS A literature review was conducted using MEDLINE, Ovid, Science Direct, Web of Science and Cochrane Database of Systematic Reviews databases with keywords:hypertension, hypotension, renin-angiotensin-aldosterone system, dopaminergic receptors, blood pressure, antipsychotics. Inclusion criteria were human or animal studies, systematic reviews, meta-analyses, randomized controlled trials, case report/series, published in selected for inclusion. RESULTS AND DISCUSSION All 5 dopamine receptor subtypes (ie D1, D2, D3, D4 and D5) regulate sodium excretion and BP. The D1, D3 and D4 receptors interact directly with the renin-angiotensin-aldosterone system, whereas D2 and D5 receptors directly interact with the sympathetic nervous system to regulate BP. Use of dopaminergic agonists or antagonists could therefore disturb the regulation of BP by dopamine receptors. WHAT IS NEW AND CONCLUSION Based upon this review, individuals on antipsychotic agents, particularly clozapine, should be routinely monitored for hypertension, and addition of antihypertensive agents such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) is indicated if hypertension occurs.
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Affiliation(s)
- N H Gonsai
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - V H Amin
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - C G Mendpara
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - R Speth
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - G M Hale
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
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Evidence and decision algorithm for the withdrawal of antipsychotic treatment in the elderly with dementia and neuropsychiatric symptoms. Eur J Clin Pharmacol 2017; 73:1389-1398. [DOI: 10.1007/s00228-017-2314-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
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Nguyen B, Du C, Bastiampillai T, Dhillon R, Tibrewal P. Successful clozapine re-challenge following myocarditis. Australas Psychiatry 2017; 25:385-386. [PMID: 28506077 DOI: 10.1177/1039856217707394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the evidence around clozapine re-challenge following myocarditis. CONCLUSION This case adds to the 17 cases of clozapine re-challenge following myocarditis, of which 71% were successful (12 cases). This demonstrates that re-challenge could be performed safely and effectively in the context of clozapine-induced myocarditis, if accompanied by a strict and rigorous monitoring protocol.
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Affiliation(s)
- Bang Nguyen
- Medical Student, University of Adelaide, Adelaide, SA, Australia
| | - Charles Du
- Medical Student, University of Adelaide, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Executive Director, Mental Health Strategy, SA Health, Government of South Australia, Adelaide, SA, and; Mental Health Systems Research, Department of Psychiatry, Flinders University, Bedford Park, SA, and; SAHMRI - Mind & Brain Research Fellow
| | - Rohan Dhillon
- Medical Lead, Western Mental Health Services, CALHN, Cramond Clinic, The Queen Elizabeth Hospital, Woodville, SA Australia
| | - Prashant Tibrewal
- Consultant Psychiatrist, Cramond Clinic, The Queen Elizabeth Hospital, Woodville, SA, Australia
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Hassine H, Ouali U, Ouertani A, Jomli R, Nacef F. Clozapine-induced DRESS syndrome with multiple and rare organ involvement. Asian J Psychiatr 2017; 28:146-147. [PMID: 28784369 DOI: 10.1016/j.ajp.2017.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Haifa Hassine
- Department of Psychiatry A, Razi Mental Health Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Uta Ouali
- Department of Psychiatry A, Razi Mental Health Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Abdelhafidh Ouertani
- Department of Psychiatry A, Razi Mental Health Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Rabaa Jomli
- Department of Psychiatry A, Razi Mental Health Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Fethi Nacef
- Department of Psychiatry A, Razi Mental Health Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Begas E, Tsakalof A, Dardiotis E, Vatidis GE, Kouvaras E, Asprodini EK. Development and validation of a reversed-phase HPLC method for licarbazepine monitoring in serum of patients under oxcarbazepine treatment. Biomed Chromatogr 2017; 31. [PMID: 28182284 DOI: 10.1002/bmc.3950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/01/2017] [Accepted: 02/07/2017] [Indexed: 11/06/2022]
Abstract
Licarbazepine is the pharmacologically active metabolite of oxcarbazepine, a drug indicated for the treatment of partial seizures and bipolar disorders. Several HPLC methods have been developed thus far but there is lack of control for interferences from antipsychotic drugs. The aim of the present study was to develop a simple, low-cost and reliable HPLC-UV method for the determination of licarbazepine in human serum in the presence of co-administered antiepileptic, antipsychotic and commonly prescribed drugs. Sample preparation consisted of a single protein precipitation step with methanol. Separation lasted ~9 min on a reversed-phase C18 column using a mobile phase composed of 50 mm sodium-dihydrogen-phosphate-monohydrate/acetonitrile (70:30, v/v) delivered isocratically at 0.9 mL/min and 30°C. Wavelength was 210 nm and calibration curve was linear with r2 0.998 over the range 0.2-50.0 μg/mL. Coefficient of variation was <5.03% and bias <-4.92%. Recovery ranged from 99.49 to 104.52% and the limit of detection was 0.0182 μg/mL. No interferences from the matrix or from antiepileptic, antipsychotic and commonly prescribed drugs were observed. The method was applied to serum samples of patients under oxcarbazepine treatment and proved to be a useful tool for the therapeutic drug monitoring of licarbazepine during monotherapy or adjunctive treatment of seizures or affective disorders.
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Affiliation(s)
- Elias Begas
- Laboratory of Pharmacology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Andreas Tsakalof
- Laboratory of Chemistry, School of Medicine, University of Thessaly, Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | | | - Evangelos Kouvaras
- Laboratory of Pharmacology, School of Medicine, University of Thessaly, Larissa, Greece
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Abstract
OBJECTIVE Complex treatment decisions can be suboptimal due to lack of a reliable decision-making model, a need this paper aims to meet. METHOD A model for making complex treatment decisions is introduced. RESULTS The utility of the proposed method is demonstrated by making a complex treatment decision involving evaluation of clozapine treatment in a treatment-resistant patient. CONCLUSION The proposed method implemented as a software tool can provide a framework for shared decision-making involving the patient.
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Affiliation(s)
- Irosh Fernando
- Staff Specialist Psychiatrist, Hunter New England Local Area Health District, Newcastle Mental Health Service, Newcastle, NSW, and; Conjoint Lecturer, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, and; PhD Candidate, School of Electrical Engineering and Computer Science, University of Newcastle, Newcastle, NSW, Australia
| | - Frans Henskens
- Associate Professor, School of Electrical Engineering and Computer Science (Computer Science and Software Engineering), University of Newcastle, Newcastle, NSW, Australia
| | - Masoud Talebian
- Lecturer, School of Mathematical and Physical Sciences (Mathematics), University of Newcastle, Newcastle, NSW, Australia
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Combs BL, Cox AG. Update on the treatment of Parkinson's disease psychosis: role of pimavanserin. Neuropsychiatr Dis Treat 2017; 13:737-744. [PMID: 28331324 PMCID: PMC5352252 DOI: 10.2147/ndt.s108948] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) has a prevalence of nearly 1 million people in the USA, with increasing incidence in the elderly population. Generally, the age of presentation is between 55 and 65 years, with the likelihood of diagnosis increasing as patients reach the age of 80 years or above. Some of the common treatments for PD increase dopamine levels in the brain. Dopaminergic therapy helps to improve motor and non-motor symptoms, but it is not without risks. Dopaminergic therapy can cause confusion, delirium, and psychotic-like behavior. It is recommended that these agents are used cautiously in patients with a history of psychosis due to the risk of exacerbation. It is unclear whether Parkinson's disease psychosis (PDP) is due to the disease itself, the treatment, or a combination of both, but it is clear that a safe, effective treatment is necessary. Second-generation (atypical) antipsychotics are the current choice of therapy for PDP. All of these agents have a black box warning from the US Food and Drug Administration (FDA) for elevated risk of mortality in elderly patients with dementia-related psychosis. Pimavanserin (Nuplazid®) received its novel drug approval by the FDA on April 29, 2016, to treat hallucinations and delusions associated with psychosis experienced by some people with PD. We review in this article the new research that led to this approval as well as its potential place in therapy.
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Affiliation(s)
- Brianna L Combs
- Department of Pharmaceutical Sciences, Sullivan University College of Pharmacy, Louisville, KY, USA
| | - Arthur G Cox
- Department of Pharmaceutical Sciences, Sullivan University College of Pharmacy, Louisville, KY, USA
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Discriminative stimulus properties of 1.25 mg/kg clozapine in rats: Mediation by serotonin 5-HT 2 and dopamine D 4 receptors. Brain Res 2016; 1648:298-305. [DOI: 10.1016/j.brainres.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022]
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Osman M, Devadas V. Clozapine-induced dysphagia with secondary substantial weight loss. BMJ Case Rep 2016; 2016:bcr-2016-216445. [PMID: 27543610 DOI: 10.1136/bcr-2016-216445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Dysphagia is listed as a 'rare' side effect following clozapine treatment. In this case report, we describe how significant clozapine-induced dysphagia has led to significant reduction of nutritional intake with subsequent substantial weight loss. An 18-year-old single man with an established diagnosis of treatment-resistant paranoid schizophrenia recovered well on a therapeutic dose of clozapine. However, he was noted to lose weight significantly (up to 20% of his original weight) as the dose was uptitrated. This was brought about by development of dysphagia, likely to be due to clozapine. Addition of nutritional supplementary liquids and initiation of a modified behavioural dietary/swallowing programme, while repeatedly mastering the Mendelsohn manoeuvre technique, alleviated the swallowing difficulties and restored his weight.
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Affiliation(s)
- Mugtaba Osman
- Department of Psychiatry, Letterkenny General Hospital, Letterkenny, Ireland
| | - Vekneswaran Devadas
- Department of Psychiatry, Letterkenny General Hospital, Letterkenny, Ireland
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Orsolini L, Tomasetti C, Valchera A, Vecchiotti R, Matarazzo I, Vellante F, Iasevoli F, Buonaguro EF, Fornaro M, Fiengo ALC, Martinotti G, Mazza M, Perna G, Carano A, De Bartolomeis A, Di Giannantonio M, De Berardis D. An update of safety of clinically used atypical antipsychotics. Expert Opin Drug Saf 2016; 15:1329-47. [PMID: 27347638 DOI: 10.1080/14740338.2016.1201475] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The atypical antipsychotic (APs) drugs have become the most widely used agents to treat a variety of psychoses because of their superiority with regard to safety and tolerability profile compared to conventional/'typical' APs. AREAS COVERED We aimed at providing a synthesis of most current evidence about the safety and tolerability profile of the most clinically used atypical APs so far marketed. Qualitative synthesis followed an electronic search made inquiring of the following databases: MEDLINE, Embase, PsycINFO and the Cochrane Library from inception until January 2016, combining free terms and MESH headings for the topics of psychiatric disorders and all atypical APs as following: ((safety OR adverse events OR side effects) AND (aripiprazole OR asenapine OR quetiapine OR olanzapine OR risperidone OR paliperidone OR ziprasidone OR lurasidone OR clozapine OR amisulpride OR iloperidone)). EXPERT OPINION A critical issue in the treatment with atypical APs is represented by their metabolic side effect profile (e.g. weight gain, lipid and glycaemic imbalance, risk of diabetes mellitus and diabetic ketoacidosis) which may limit their use in particular clinical samples. Electrolyte imbalance, ECG abnormalities and cardiovascular adverse effects may recommend a careful baseline and periodic assessments.
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Affiliation(s)
- L Orsolini
- a School of Life and Medical Sciences , University of Hertfordshire , Hatfield , Herts , United Kingdom.,b Villa San Giuseppe Hospital, Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - C Tomasetti
- c Polyedra Research Group , Teramo , Italy.,e NHS, Department of Mental Health ASL Teramo , Psychiatric Service of Diagnosis and Treatment, Hospital 'Maria SS dello Splendore,' Giulianova , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - A Valchera
- b Villa San Giuseppe Hospital, Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy
| | - R Vecchiotti
- b Villa San Giuseppe Hospital, Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - I Matarazzo
- g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini,' Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
| | - F Vellante
- g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini,' Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
| | - F Iasevoli
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - E F Buonaguro
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - M Fornaro
- c Polyedra Research Group , Teramo , Italy.,i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | | | - G Martinotti
- h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
| | - M Mazza
- c Polyedra Research Group , Teramo , Italy.,j Department of Life, Health and Environmental Sciences , University of L'Aquila , L'Aquila , Italy
| | - G Perna
- k Department of Clinical Neurosciences , Hermanas Hospitalarias, FoRiPsi, Villa San Benedetto Menni, Albese con Cassano , Como , Italy.,l Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine , University of Miami , Miami , FL , USA
| | - A Carano
- m NHS, Department of Mental Health ASL Ascoli Piceno, Psychiatric Service of Diagnosis and Treatment , Hospital 'Maria SS del Soccorso,' San Benedetto del Tronto , Italy
| | - A De Bartolomeis
- f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - M Di Giannantonio
- i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | - D De Berardis
- c Polyedra Research Group , Teramo , Italy.,g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini,' Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
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48
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Abstract
Antipsychotic drugs have been the drugs of choice for the treatment of schizophrenia ever since the introduction of chlorpromazine in the early 1950s of the last century. Since then, about 60 different antipsychotics have been introduced. Although pharmacologically these drugs show large differences, in terms of potency, duration of action and selectivity, all antipsychotics appear to reduce the positive symptoms of schizophrenia, while having little or no effect on the negative symptoms or the cognitive deficits. The only apparent exception is clozapine, which is also effective in therapy-resistant patients. On the other hand, antipsychotics induce significant side effects as well, including neurological, behavioural and metabolic side effects. In the present paper, we will discuss the preclinical pharmacology of the current antipsychotic drugs focussing both on the therapeutic and on side effects of these drugs.
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49
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Remington G, Lee J, Agid O, Takeuchi H, Foussias G, Hahn M, Fervaha G, Burton L, Powell V. Clozapine’s critical role in treatment resistant schizophrenia: ensuring both safety and use. Expert Opin Drug Saf 2016; 15:1193-203. [DOI: 10.1080/14740338.2016.1191468] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- G. Remington
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - J. Lee
- Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore
| | - O. Agid
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - H. Takeuchi
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - G. Foussias
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - M. Hahn
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - G. Fervaha
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - L. Burton
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - V. Powell
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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50
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Hasan A. Clozapine-induced Gastrointestinal Hypomotility--New Objective Evidence for an Underestimated Side-effect. EBioMedicine 2016; 5:12-3. [PMID: 27077100 PMCID: PMC4816826 DOI: 10.1016/j.ebiom.2016.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
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