Clozapine serum concentrations in dopamimetic psychosis in Parkinson’s disease and related disorders

Lutz, Ulrich; Sirfy, Ahmad; Wiatr, Gerlinde; Altpass, Danuta; Farger, Gisbert; Gasser, Thomas; Karle, Kathrin N.; Batra, Anil

doi:10.1007/s00228-014-1772-0

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…The dose for this latter condition is 5- to 10-fold lower than in TRS. 15 Off-label uses of clozapine include treatment of schizophrenia in patients younger than 18 years, bipolar disorder, depressive disorders, borderline personality disorder, substance misuse disorders, suicidality, aggression, tardive dyskinesia and tardive dystonia. 16 The regulations surrounding the use of clozapine in TRS also apply to these latter groups of patients.…”

Section: Introductionmentioning

confidence: 99%

Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals

Flanagan

Lally

Gee

et al. 2020

British Medical Bulletin

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Background Clozapine remains the only medication licensed for treating refractory schizophrenia. However, it remains underutilized in part due to concerns regarding adverse events. Sources of data Published literature. Areas of agreement Common adverse events during clozapine treatment include sedation, hypersalivation, postural hypotension, dysphagia, gastrointestinal hypomotility, weight gain, diabetes mellitus and dyslipidaemia. Rare but serious events include agranulocytosis, cardiomyopathy, myocarditis, pneumonia, paralytic ileus and seizure. Areas of controversy It remains unclear how best to minimize clozapine-induced morbidity/mortality (i) during dose titration, (ii) from hypersalivation and (iii) from gastrointestinal hypomotility. It is also unclear how clozapine pharmacokinetics are affected by (i) gastrointestinal hypomotility, (ii) systemic infection and (iii) passive exposure to cigarette smoke. Whether monthly haematological monitoring needs to continue after 12 months of uninterrupted therapy is also a subject of debate. Growing points There is a need for better management of serious clozapine-related adverse events in addition to agranulocytosis. There is also a need for better education of patients and carers, general practitioners, A&E and ITU staff and others of the problems posed in using clozapine safely. Areas timely for developing research There is a need for more research on assessing clozapine dosage (i) as patients get older, (ii) with respect to exposure to cigarette smoke and (iii) optimizing response if adverse events or other factors limit dosage.

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Section: Introductionmentioning

confidence: 99%

Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals

Flanagan

Lally

Gee

et al. 2020

British Medical Bulletin

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“…New research has shown that the indication-specific target plasma concentration for clozapine is between 15 and 141 ng/mL 24. SGAs, such as clozapine, are thought to treat hallucinations by blocking dopamine D 2 receptors in the brain.…”

Section: Introductionmentioning

confidence: 99%

Update on the treatment of Parkinson’s disease psychosis: role of pimavanserin

Combs¹,

Cox²

2017

NDT

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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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“…Is it better to withhold the most efficacious drugs instead of closely monitoring these drugs' side effects? In a retrospective study of 35 PDP patients, the mean serum concentration of clozapine was much lower in PD patients than the mean concentration future science group www.futuremedicine.com reported in schizophrenic patients (77.9 vs 350-600 ng/ml) with no serious adverse events were documented related to clozapine [63]. Are frequent blood tests or the side effect profile the main barrier for a clozapine prescription?…”

Section: Should Clinicians Be Doing More To Address Pdp?mentioning

confidence: 91%

Parkinson’s Disease Psychosis: Therapy Tips and the Importance of Communication Between Neurologists and Psychiatrists

Martínez-Ramírez

Okun

Jaffee

2016

Neurodegener. Dis. Manag.

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Parkinson's disease (PD) is a chronic and complex neurodegenerative disorder resulting in a mixture of motor and nonmotor symptoms. Psychosis develops in around 60% of PD patients during and can be one of the most challenging nonmotor symptoms. PD psychosis is considered the single greatest precipitant for nursing home placement. PD psychosis is an independent predictor of increased mortality, and there is no 'ideal' or universal treatment strategy. The treatment approach to PD psychosis should be tailored and individualized for each patient. In this review, we will discuss PD psychosis and provide practical treatment considerations for neurologists, psychiatrists and other healthcare professionals. We stress the importance of real-time communication between members of the healthcare team.

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Clozapine serum concentrations in dopamimetic psychosis in Parkinson’s disease and related disorders

Cited by 17 publications

References 25 publications

Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals

Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals

Update on the treatment of Parkinson’s disease psychosis: role of pimavanserin

Parkinson’s Disease Psychosis: Therapy Tips and the Importance of Communication Between Neurologists and Psychiatrists

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Clozapine serum concentrations in dopamimetic psychosis in Parkinson’s disease and related disorders

Cited by 17 publications

References 25 publications

Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals

Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals

Update on the treatment of Parkinson&rsquo;s disease psychosis: role of pimavanserin

Parkinson’s Disease Psychosis: Therapy Tips and the Importance of Communication Between Neurologists and Psychiatrists

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Product

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Update on the treatment of Parkinson’s disease psychosis: role of pimavanserin