Augmenting amisulpride with clozapine had led to unmasking of akathisia

Ray, Anirban; Munshi, Santanu

doi:10.4103/0972-6748.119638

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…In terms of spontaneous case report's authors have described acute and tardive nocturnal akathisia, akathisia in children and akathisia on augmentation of clozapine with amisulpride (for details see). [ 5 ] Our case description adds to these findings.…”

Section: Discussionsupporting

confidence: 53%

Clozapine induced akathisia: A case report and review of the evidence

Grover

Sahoo

2015

Indian J Pharmacol

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Clozapine is a second-generation antipsychotic medication, which is mostly used in patients with treatment resistant schizophrenia. It is considered to be associated with lower incidence of extrapyramidal side-effects. Akathisia is considered to be a rare side-effect of clozapine. In this report, we describe a patient who developed akathisia while receiving clozapine and review the literature. Existing literature suggests that except for few initial reports, data suggests that clozapine is in general associated with lower incidence of akathisia compared to first generation antipsychotics. Data comparing clozapine with other atypical antipsychotics is equivocal.

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Section: Discussionsupporting

confidence: 53%

Clozapine induced akathisia: A case report and review of the evidence

Grover

Sahoo

2015

Indian J Pharmacol

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“…This correlation has been reviewed in the literature and the results are debated, as plasma concentration, rather than clozapine daily dose, seems to have an impact on metabolic changes [ 42 ]. One study confirms a high prevalence of metabolic side effects with clozapine and suggested higher clozapine level and certain pharmacogenetic markers as important predictors of metabolic syndrome [ 43 ].…”

Section: Discussionmentioning

confidence: 97%

Metabolic Syndrome in Adults Receiving Clozapine; The Need for Pharmacist Support

Hurley

O’Brien²,

Halleran

et al. 2023

Pharmacy

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People who are diagnosed with treatment resistant schizophrenia (TRS) are likely to have clozapine as a therapeutic management option. There is a high prevalence of metabolic syndrome in patients receiving clozapine. To mitigate against this, monitoring of weight, waist circumference, lipid profile, glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and blood pressure (BP) is recommended. The aims of this study were to examine the prevalence of metabolic syndrome and whether any variables were correlated with its development, and to highlight any opportunities for the pharmacist to offer support. This study was conducted in an urban hospital and its associated Clozapine Clinic in Cork, Ireland. A retrospective audit assessed the prevalence of metabolic syndrome using the International Diabetes Federation (IDF) criteria. Patients were eligible for inclusion if they were aged 18 years or more, registered with the Clozapine Clinic, and had the capacity to provide informed consent. All data were entered into Microsoft® Excel ® (Microsoft Corporation) and further statistical analysis was undertaken using R, T-tests, Fisher’s Exact Test and Mann–Whitney U tests as appropriate, and p ≤ 0.05 was considered statistically significant. Of 145 patients (32% female; mean age (SD) 45.3 (±11.7) years; 86.2% living independently/in family home), nearly two thirds (n = 86, 59.3%) were diagnosed with metabolic syndrome. The mean age of participants with metabolic syndrome was 44.4 years (SD = 10.8), similar to the 46.6 years (SD = 12.8) for those without. Variables that were identified to be statistically significantly associated with metabolic syndrome included waist circumference, weight, triglycerides, high density lipoprotein-cholesterol (HDL-C), BP, FBG and HbA1c. The high incidence of metabolic syndrome in this patient population highlights the need for continued physical health monitoring of these patients to ameliorate the risk of developing metabolic syndrome.

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“…Additionally, consideration must be given to drug-to-drug interactions when using multiple agents. Ray and Munshi presented a case where adding low-dose clozapine to baseline amisulpride treatment aggravated existing akathisia, with new onset dystonia and hypersalivation [ 40 ]. The authors postulated that these adverse effects were due to increased serum amisulpride levels due to interaction with clozapine, which has been reported previously [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia—Case Reports and Discussion

Harrison

Haeney

Brereton

2021

Case Reports in Psychiatry

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Treatment resistance in schizophrenia is often encountered in clinical practice, with clozapine usually recommended as the appropriate therapy. However, where clozapine proves ineffective or cannot be tolerated due to side effects, treatment options are limited. In patients within forensic mental health services, residual symptomatology often presents a barrier to discharge and can have lasting effects on prospects for rehabilitation as well as risk to self and others. This paper presents a review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment. In all three patients, it improved clinical efficacy as well as tolerability, resulting in improvement that allowed discharge from the forensic hospital.

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Augmenting amisulpride with clozapine had led to unmasking of akathisia

Cited by 6 publications

References 8 publications

Clozapine induced akathisia: A case report and review of the evidence

Clozapine induced akathisia: A case report and review of the evidence

Metabolic Syndrome in Adults Receiving Clozapine; The Need for Pharmacist Support

Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia—Case Reports and Discussion

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