Cardiac risk at the onset of treatment in patients treated with benzodiazepines and clozapine

Borentain, Stephane; Millet, Bruno; Olié, J.-P.

doi:10.1016/s0924-9338(02)00699-5

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…Munro et al (13) reported a 40% discontinuation rate for clozapine with the highest discontinuation frequency within the first year of treatment. In worst case, rapid dose titration can cause cardiovascular collapse, and in addition to this, concomitant benzodiazepines should be employed with considered caution during titration (71)(72)(73). Early discontinuation of clozapine treatment before its benefits are detectable could therefore preclude patients from receiving the best-evidenced and efficient treatment for treatmentresistant schizophrenia.…”

Section: Dosing Of Clozapinementioning

confidence: 99%

Optimizing clozapine treatment

Nielsen

Damkier

Lublin

et al. 2011

Acta Psychiatrica Scandinavica

146

136

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Section: Dosing Of Clozapinementioning

confidence: 99%

Optimizing clozapine treatment

Nielsen

Damkier

Lublin

et al. 2011

Acta Psychiatrica Scandinavica

146

136

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“…Borentain et al 4 described a case involving a 28-yearold man who was taking clonazepam when CLZ was initiated. Ten days after CLZ was started, the patient collapsed and lost consciousness.…”

Section: Case Reports Concerning Adverse Eventsmentioning

confidence: 99%

Safety Evaluation of the Concomitant Use of Clozapine and Benzodiazepines: A Retrospective, Cross-Sectional Chart Review

Bitter¹,

Demler²,

Opler³

2008

Journal of Psychiatric Practice

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No deaths occurred as a result of concomitant BZD and CLZ use in the sample examined in this study, suggesting that CLZ and BZD may be safely used concomitantly in many cases. Further study is needed to determine patient characteristics or predisposing factors that might put patients at higher risk of death from this interaction. Our findings are limited by the small sample size and suboptimal frequency of side effect measurements (e.g., measurements of blood pressure and heart rate, reports of hypotensive episodes). Confounding variables that might also play a role in interactions between CLZ and BZDs, but which were not measured in this study, include other types of respiratory compromise, cognitive dysfunction, and organ dysfunction. Precautionary measures that may be used when initiating concomitant CLZ and BZD therapy include slow titration of CLZ, blood pressure monitoring, and/or nightly pulse oximeter measurements.

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“…Im Rahmen einer Kombination von Clozapin und Benzodiazepinen wurden gelegentlich schwerwiegende Komplikationen beobachtet [1,4,5,7,9,11,16]. In einigen Fällen kam es zum Kreislaufkollaps [4,5,9,16], vereinzelte Todesfälle aufgrund von Herzstillstand und/oder Atemdepression sind beschrieben, insbesondere bei intravenöser Applikation von Benzodiazepinen [4,11].…”

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“…In einigen Fällen kam es zum Kreislaufkollaps [4,5,9,16], vereinzelte Todesfälle aufgrund von Herzstillstand und/oder Atemdepression sind beschrieben, insbesondere bei intravenöser Applikation von Benzodiazepinen [4,11]. Bislang sind weltweit 9 Fäl-le mit schwerem Kreislaufkollaps sowie 4 Todesfälle unter dieser Kombinationsbehandlung publiziert [4]. Der Arzneimittelkommission der Deutschen Ärzteschaft (AkdÄ) liegen bislang 43 Meldungen von Verdachtsfällen eines Zwischenfalls unter dieser Medikamentenkombination vor, darunter 4 Todesfälle, 4 Fälle mit Herzstillstand und 3 Fälle mit Atemdepression (Gemeinsame Datenbank des BfArM und der AkdÄ-deutsches Spontanerfassungssystem, Stand 25.…”

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Zur Problematik der Kombination von Clozapin mit Benzodiazepinen

et al. 2004

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Serious adverse events and even sudden death have been reported during administration of the combination of clozapine and benzodiazepines. However, this combination does not necessarily result in increased frequency of serious adverse events. Thus it is not regarded as an absolute contraindication and might be useful in distinct clinical situations, e.g., during the occurrence of a malignant neuroleptic syndrome, "catatonic dilemma," or severe agitation during clozapine treatment. In the following report, certain suggestions on how to deal with this combination therapy are provided which may provide a basis for discussion that ultimately may lead to the formulation of guidelines for this combination therapy. Such guidelines may help psychiatrists in dealing with this combination in clinical situations. Moreover, the formulation of such guidelines would help with forensic issues in case of serious adverse events occurring during this combination therapy.

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Cardiac risk at the onset of treatment in patients treated with benzodiazepines and clozapine

Cited by 7 publications

References 4 publications

Optimizing clozapine treatment

Optimizing clozapine treatment

Safety Evaluation of the Concomitant Use of Clozapine and Benzodiazepines: A Retrospective, Cross-Sectional Chart Review

Zur Problematik der Kombination von Clozapin mit Benzodiazepinen

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