How and when to use clozapine

Rubio, José M.; Kane, John M.

doi:10.1111/acps.13111

Cited by 34 publications

(43 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to several studies, 30% of patients diagnosed with schizophrenia are resistant to treatment, in which case clozapine should be introduced [47,48]. Our study con rms the underuse of clozapine in treatment-resistant schizophrenia (TRS) [49], being more common antipsychotic augmentation and higher doses of antipsychotic [50]. Overall, the prevalence of clozapine use was signi cantly higher in young patients (15-40 years) and in prevalent users.…”

Section: Discussionsupporting

confidence: 65%

Treatment Patterns and Appropriateness of Antipsychotic Prescriptions in Patients with Schizophrenia

Gamón

Hurtado

Salazar-Fraile

et al. 2021

Preprint

View full text Add to dashboard Cite

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although this mental disorder has a low prevalence in comparison to other mental conditions, it has a negative impact on social and occupational functioning. This study is aimed to assess the inappropriateness of antipsychotic medication among schizophrenic patients and describe current patterns in the treatment of schizophrenia. A retrospective cohort study was conducted including all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. 19,718 patients with a diagnosis of schizophrenia and treated with antipsychotic medication were identified. The main outcome was inappropriateness of the pharmacotherapeutic management, including polypharmacy use: 30.4% of patients received antipsychotic polypharmacy (6.8% were prescribed 3 or more antipsychotics); overdosage: a total of 318 individuals (1.6%) exceeded the maximum daily doses; and use of concomitant psychotropics without an associated diagnosis: 21.5% of patients received psychotropic drugs concomitantly without associated psychiatric diagnoses. Overall, females and those who had a comorbid condition, such as anxiety or depression, were less likely to receive antipsychotic polypharmacy. In contrast, concomitant treatment with other psychoactive drugs, such as antiparkinson drugs, anxiolytics and hypnotics and more visits to mental health hospital increased the risk of polypharmacy use. In conclusion, a high level of inappropriateness has been detected among antipsychotic prescriptions. Practitioners should follow guidelines recommendations whenever possible in order to obtain the maximum benefit of antipsychotic medications without an increased risk of adverse effects in patients.

show abstract

Section: Discussionsupporting

confidence: 65%

Treatment Patterns and Appropriateness of Antipsychotic Prescriptions in Patients with Schizophrenia

Gamón

Hurtado

Salazar-Fraile

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The antipsychotic medication, clozapine, has the most convincing evidence for benefit in treatment-resistant schizophrenia and there are indications that it can reduce aggression, suicidality and mortality in schizophrenia. 1 – 3 Weighing up the risks and benefits of clozapine treatment in any individual involves the assessment of adverse effects. These include several uncommon but serious problems, such as neutropenia/agranulocytosis, myocarditis/cardiomyopathy, 4 , 5 pneumonia 6 and seizures.…”

Section: Introductionmentioning

confidence: 99%

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

Barnes

MacCabe

Kane

et al. 2020

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

Background: In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine. Methods: NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice. Results: Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations. Of 481 patients treated with clozapine for up to 18 weeks, there was documented pretreatment screening of blood pressure, heart rate and ECG in at least 90%, and body weight, plasma lipids, plasma glucose/glycated haemoglobin (HbA1c) and physical examination in approximately 80%. During the first 2 weeks of clozapine treatment there was documented daily measurement of both heart rate and blood pressure in 82% and body temperature in 77%. In a subsample of 411 patients, of the 72% who had weekly side-effect assessments documented in the first month of treatment, a structured assessment tool had been used in 29%. Treatment monitoring up to 18 weeks included an ECG in 90%, C-reactive protein (CRP) or creatine kinase in 42%, and troponin or B-type natriuretic peptide (BNP) in 29%. In the 5908 patients prescribed clozapine for at least 1 year, blood pressure and body weight/body mass index were documented in at least 80%, plasma lipids in 78% and plasma glucose in 73%, with an ECG in 55%. Two-thirds were prescribed medication to manage side effects of clozapine and one third of those with a diagnosis of schizophrenia were prescribed a second antipsychotic medication. Conclusion: The findings suggest that for most patients treated with clozapine in UK mental health services, physical health screening and side-effect monitoring follow recommended practice, but there was limited use of structured side-effect assessment tools. Monitoring for clozapine-induced myocarditis during the early risk period using markers of inflammation such as CRP, and cardiac damage such as troponin and BNP, was less consistent. This may partly reflect the variation in guideline recommendations for monitoring for myocarditis and partly the selected use of such tests when prompted by cardiac symptoms. The relatively common coprescription of medications for the majority of people on longer-term clozapine treatment may well further increase side-effect burden and physical health risks, reinforcing the need for continuing systematic monitoring.

show abstract

“…This proportion reflects an underuse of this drug, as research has shown that clozapine is indicated in up to 30% of patients diagnosed with treatment-resistant schizophrenia 50 – 52 . Instead, these patients are more frequently treated with additional antipsychotics and higher doses 53 . Overall, the prevalence of clozapine use was significantly higher in young patients (15–40 years) and in prevalent users.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns and appropriateness of antipsychotic prescriptions in patients with schizophrenia

Gamón

Hurtado

Salazar-Fraile

et al. 2021

Sci Rep

View full text Add to dashboard Cite

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although it has a low prevalence compared to other mental conditions, it has a negative impact on social and occupational functions. This study aimed to assess the appropriateness of antipsychotic medications administered to schizophrenic patients and describe current treatment patterns for schizophrenia. A retrospective cohort study was conducted in all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. A total of 19,718 patients were eligible for inclusion. The main outcome assessed was inappropriateness of the pharmacotherapeutic management, including polypharmacy use. Altogether, 30.4% of patients received antipsychotic polypharmacy, and 6.8% were prescribed three or more antipsychotics. Overdosage affected 318 individuals (1.6%), and 21.5% used concomitant psychotropics without an associated psychiatric diagnosis. Women and people with a comorbid condition like anxiety or depression were less likely to receive antipsychotic polypharmacy. In contrast, increased polypharmacy was associated with concomitant treatment with other psychoactive drugs, and only in user on maintenance therapy, with more visits to the mental health hospital. Overall, we observed a high level of inappropriateness in antipsychotic prescriptions. Greater adherence to guidelines could maximize the benefits of antipsychotic medications while minimizing risk of adverse effects.

show abstract

How and when to use clozapine

Cited by 34 publications

References 73 publications

Treatment Patterns and Appropriateness of Antipsychotic Prescriptions in Patients with Schizophrenia

Treatment Patterns and Appropriateness of Antipsychotic Prescriptions in Patients with Schizophrenia

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

Treatment patterns and appropriateness of antipsychotic prescriptions in patients with schizophrenia

Contact Info

Product

Resources

About