Association of autonomic dysfunction and clozapine

Cohen, Hagit; Loewenthal, Uri; Matar, Michael A.; Kotler, Moshe

doi:10.1192/bjp.179.2.167

Cited by 122 publications

(44 citation statements)

References 17 publications

(25 reference statements)

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“…Moreover, there are a few reports regarding autonomic dysfunction with increased adrenergic activity in patients receiving prolonged clozapine treatment. Patients treated with clozapine exhibited marked differences in autonomic nervous system functioning compared with those treated with olanzapine as shown by increased heart rate and low-frequency components and lower HRV and high-frequency components (Cohen et al 2001). This reflects a basal autonomic dysfunction with increased sympathetic and decreased parasympathetic tone.…”

Section: Discussionmentioning

confidence: 97%

Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients

Woo

Kim

Chae

et al. 2009

The World Journal of Biological Psychiatry

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Section: Discussionmentioning

confidence: 97%

Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients

Woo

Kim

Chae

et al. 2009

The World Journal of Biological Psychiatry

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“…A study in healthy controls [Pfizer, data on file] found that similar high doses produced minimal change in QTc when dosed for 2 weeks. A recent report [21] found that long-term administration of a mean of 15.4 mg of haloperidol in a study of 56 patients meeting DSM-IV criteria for schizophrenia and of 53 healthy controls, was associated with a lower HR than clozapine but a higher QTc than clozapine, olanzapine or normal controls (p < 0.0001). It also was associated with the lowest PR interval and a similar QRS to that found in controls.…”

Section: Antipsychoticsmentioning

confidence: 93%

“…Another study reported that long-term administration of clozapine at a dose of 300 -700 mg/day led to a mean QTc and HR greater than controls (107 versus 62, both p < 0.0001) [21]. Finally, a retrospective review of 61 patients [26] found that the prevalence of ECG abnormalities increased from 13.6 to 31.1% after clozapine initiation.…”

Section: Antipsychoticsmentioning

confidence: 96%

“…A study of intramuscular olanzapine showed no impact on the QTc [37]. However, long-term oral administration at a mean dose of 14.8 mg/day showed significant mean QTc measurement versus controls (504.6 versus 370 ms, p < 0.0001) [21]. Prolonged QTc was found in 65% of patients receiving olanzapine.…”

Section: Antipsychoticsmentioning

confidence: 97%

“…There have been three reports of effects of clozapine in patients with schizophrenia [21,25,26]. The first was conducted among 51 in-patients before and after ∼ 2 weeks of one of four antipsychotics (amisulpride, olanzapine, sertindole, clozapine).…”

Section: Antipsychoticsmentioning

confidence: 99%

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Psychotropic drugs and the ECG: focus on the QTc interval

Goodnick

Jerry²,

Parra³

2002

Expert Opinion on Pharmacotherapy

101

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The QT interval measuring depolarisation and repolarisation has, when lengthened, been implicated as a risk factor for the development of torsades de pointes and sudden death, particularly in patients predisposed to these complications due to cardiovascular impairment. Since some of the medications used in psychiatry have been implicated, an extensive review of available literature was made of the major classes, including antipsychotics, antidepressants, lithium, anticonvulsants and benzodiazepines. Further, where no publications were found on a particular medication, the pharmaceutical firms responsible for these items were contacted concerning possibly unpublished data. Results of the survey indicate that there may be difficulty in one of three situations: immediate (in the first minutes to hours after oral or parenteral administration), short-term use of 4 - 12 weeks or long-term use of 6 months. Based on this approach, the greatest concern is directed at the immediate application of haloperidol, droperidol, pimozide and trazodone, the short-term use of thioridazine, pimozide, sertindole, nortriptyline, clomipramine, doxepin and the long-term use of clozapine, olanzapine and carbamazepine. It is of interest that a reduction in QTc is reported with aripiprazole. Among the antidepressants, the tertiary tricyclic antidepressants (imipramine, amitriptyline and doxepin) appear to have a more general impact, while the secondary tricyclic antidepressants (nortriptyline, desipramine) may impact more on children and the elderly. Among other antidepressants, the only reports of torsades de pointes appeared to occur with mirtazapine. It was also of interest to find data showing no effect or reductions in QTc produced by sertraline, citalopram, paroxetine and bupropion in multiple studies. Effects of medications on other heart parameters are also briefly reviewed. In particular, the safety of sertraline in post-MI patients and of bupropion in heart disease patients is highlighted. Little information was available on other classes of medications used in psychiatric disorders. What is available concerning lithium, the anticonvulsants and the benzodiazepines indicates little effect on the QTc, although there may be effects on other cardiovascular parameters.

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