Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report

Uygur, Omer Faruk; Uygur, Hilal

doi:10.1080/24750573.2019.1627695

Cited by 2 publications

(4 citation statements)

References 34 publications

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“…73 To date, there is no conclusive evidence for detrimental neurodevelopmental and cognitive longterm effects resulting from fetal exposure to clozapine. 434,[438][439][440] Clozapine is not associated with greater teratogenic effects than other antipsychotics. [440][441][442] Furthermore, there is no evidence for increased rates of prematurity, delivery complications, or changes in birth weight and height compared with other antipsychotics.…”

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

“… 434 , 436 In most cases, the considerable risk for illness exacerbation associated with such a switch outweighs the risks associated with continued clozapine treatment during pregnancy. 436 , 439 Therefore, a thorough risk–benefit assessment is indispensable before any treatment change. Using the lowest effective dose of clozapine is especially crucial during pregnancy, however.…”

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

“…To date, there is no conclusive evidence for detrimental neurodevelopmental and cognitive long-term effects resulting from fetal exposure to clozapine 323,[327][328][329] .…”

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

“…Given its unique efficacy for TRS, for the majority of pregnant women receiving clozapine, switching to another antipsychotic is not a feasible option 323,325 . In most cases the considerable risk for illness exacerbation associated with such a switch outweighs the risks associated with continued clozapine treatment during pregnancy 325,328 . Therefore, a thorough risk-benefit assessment is indispensable before any treatment change.…”

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

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Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia

Qubad

Bittner

2023

Therapeutic Advances in Psychopharmacology

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Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine’s wide-ranging superior efficacy – for treatment-resistant schizophrenia (TRS) and beyond – and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients’ benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine’s unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine’s full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.

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Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

“…To date, there is no conclusive evidence for detrimental neurodevelopmental and cognitive long-term effects resulting from fetal exposure to clozapine 323,[327][328][329] .…”

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

Section: Pregnancy and Breastfeedingmentioning

confidence: 99%

See 2 more Smart Citations

Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia

Qubad

Bittner

2023

Therapeutic Advances in Psychopharmacology

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Second to None – Rationale, Timing, and Clinical Management of Clozapine Use in Schizophrenia

Qubad¹,

Bittner²

2022

Preprint

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Despite its continued relevance as the single most effective and important evidence-based treatment for schizophrenia, the degree of underutilization of clozapine across health systems remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to use clozapine due to its relatively large side-effect burden and its comparatively complex dosing and monitoring requirements. This underscores the necessity for continued education of clinicians in the intricacies of clozapine use and in the still growing case in favor of this vital treatment option. Consequently, this narrative review provides a comprehensive outline of all lines of evidence, which support clozapine’s wide-ranging superior efficacy, and of the current knowledge regarding the prevalence and diagnosis of treatment resistance. The distinct neurobiological and clinical characteristics of this condition makes the swift initiation of clozapine indispensable. Moreover, we review the extensive literature regarding clozapine’s side effect profile and current recommendations for optimal treatment and monitoring algorithms including for particularly vulnerable populations such as elderly patients and pregnant women and for potential re-challenges after myocarditis and neutropenia. We also discuss established approaches to increase treatment response as well as augmentation strategies for patients with partial or full clozapine resistance. We argue for a clear focus on early and consistent detection and management of side effects, which can ensure patient safety and reduce permanent all-cause discontinuation. This strategy needs to be combined with a long-term approach acknowledging the late onset of clozapine’s full advantageous effects, which – in cases like reduced mortality rates – even then may not be easily discernible. Our aim is to encourage a safer, more frequent, and timely use of clozapine to maximize patients’ short- and long-term benefits. Even now, the extent of these benefits as well as patient’s satisfaction with treatment still clearly set clozapine apart from all other available treatment options.

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Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report

Cited by 2 publications

References 34 publications

Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia

Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia

Second to None – Rationale, Timing, and Clinical Management of Clozapine Use in Schizophrenia

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