Clozapine safety monitoring and related research in psychiatry and neurology in South America: A scoping review

Baptista, Trino; Serrano, Ana; Presti, Alirio Perez Lo; Fernandez-Arana, Alberto; Elkis, Helio; Motuca, Mariano; Olmos, Ismael; Schoretsanitis, Georgios

doi:10.1016/j.schres.2023.07.029

Cited by 3 publications

(1 citation statement)

References 43 publications

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“…Different countries have different percentages of patients with predominant ancestry from the Americas, Europe, or Africa and different levels of mixed ancestry 72 . Recently, Baptista et al 73 reviewed all published clozapine research in South America and only found a myocarditis study from Venezuela, which was published in English and Spanish 74 and 3 case reports from other countries published in languages other than English 73 . A search of the international pharmacovigilance database for clozapine ADRs through January 15, 2021, identified only two myocarditis cases from Latin American countries, both from Venezuela 5 …”

Section: Discussionmentioning

confidence: 99%

Can slow personalized titration using C-Reactive Protein monitoring decrease the high rates and mortality of clozapine-associated myocarditis seen in some countries? A call for research

de Leon

2024

J Clin Psychopharmacol

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Purpose/Background The hypothesis that slower personalized titration may prevent clozapine-associated myocarditis and decrease the disproportion incidence of 3% found in Australia was not described in a recent Australian article in this journal. Methods Six countries in addition to Australia have published information suggesting a similar incidence of clozapine-associated myocarditis. On September 19, 2023, PubMed searches were updated for articles from the United States, Korea, Japan, Canada, New Zealand, and Turkey. Findings/Results An incidence of 3.5% (4/76) was found in a US hospital, but US experts were the first to propose that clozapine-associated myocarditis may be a hypersensitivity reaction associated with rapid titration and possibly preventable. Koreans and Japanese are of Asian ancestry and need lower minimum therapeutic doses for clozapine than patients of European ancestry. A 0.1% (2/1408) incidence of myocarditis during clozapine titration was found in a Korean hospital, but pneumonia incidence was 3.7% (52/1408). In 7 Japanese hospitals, 34% (37/110) of cases of clozapine-associated inflammation were found during faster titrations (based on the official Japanese titration) versus 13% (17/131) during slower titrations (based on the international titration guideline for average Asian patients). Recent limited studies from Canada, New Zealand, and Turkey suggest that slower personalized titration considering ancestry may help prevent clozapine-associated myocarditis. Implications/Conclusions Other countries have very limited published data on clozapine-associated myocarditis. Based on a recent Australian case series and these non-Australian studies, the author proposes that Australia (and other countries) should use slow personalized titration for clozapine based on ancestry and c-reactive protein monitoring.

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Section: Discussionmentioning

confidence: 99%

Can slow personalized titration using C-Reactive Protein monitoring decrease the high rates and mortality of clozapine-associated myocarditis seen in some countries? A call for research

de Leon

2024

J Clin Psychopharmacol

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Promoting safer and wider worldwide use of clozapine

de Leon

2024

Schizophrenia Research

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Severe necrotic colitis in an adolescent with polypharmacy and high clozapine doses according to his ancestry.

Baptista,

de Leon,

Guizar

et al. 2024

Investigación Clínica

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The antipsychotic drug Clozapine (CLZ) is approved for treat-ment-resistant schizophrenia and reduction in the risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. However, it is increasingly used in psychiatry and neurology worldwide in numerous off-label conditions. Clozapine is associated with diverse side effects which require careful monitor-ing in its use for prevention and treatment. The quality of CLZ use and pharma-covigilance varies considerably among Latin American countries. CLZ-induced gastrointestinal hypomotility (CIGH) is a relevant clinical problem, ranging from innocuous constipation to lethal necrotic colitis. Thus, optimal preven-tion, early detection, and treatment of CIGH deserves considerable attention. We describe here the case of a 15-year-old Mexican boy diagnosed with Opposi-tional Defiant- and Attention-Deficit/Hyperactivity Disorder who developed se-vere necrotic colitis after nine months of CLZ treatment, leading to permanent ileostomy. We ascribed this unfortunate outcome to careless polypharmacy that did not consider drug-related antimuscarinic activity, deficient clinical moni-toring, and lack of attention to ethnicity concerning drug dosing. This case is of educational value for the mental health team in order to promote the proper use of CLZ, which may be life-saving in patients with severe mental disorders.

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Clozapine safety monitoring and related research in psychiatry and neurology in South America: A scoping review

Cited by 3 publications

References 43 publications

Can slow personalized titration using C-Reactive Protein monitoring decrease the high rates and mortality of clozapine-associated myocarditis seen in some countries? A call for research

Can slow personalized titration using C-Reactive Protein monitoring decrease the high rates and mortality of clozapine-associated myocarditis seen in some countries? A call for research

Promoting safer and wider worldwide use of clozapine

Severe necrotic colitis in an adolescent with polypharmacy and high clozapine doses according to his ancestry.

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