Pilot study with clozapine in patients with HIV-associated psychosis and drug-induced parkinsonism

Abstract

Clozapine (CZP) is an atypical antipsychotic drug that does not appear to block striatal dopamine receptors. In six patients who met the criteria of HIV‐associated psychosis and who had previously developed moderate parkinsonism as a result of the use of typical neuroleptic agents, CZP was added in an open, rising dose study. Subjects were evaluated at baseline after at least 7 days without neuroleptic drugs and then monthly for 3 months of the experimental treatment using three rating scales: Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), and motor examination of the Unified Parkinson's Disease Rating Scale (UPDRS). A significant reduction in psychopathology as represented in the BPRS total score (54.2 at baseline versus 23.9 at month 3) and CGI (2 and 8, respectively) was obtained with a mean CZP dose of 27.08 mg/day. Parkinsonism also improved by an average of 76.5% at the end of the study. One patient did not complete the study as a result of a progressive decrease in leukocyte count while on CZP. These preliminary results suggest that the pharmacologic properties of CZP may be of value in the management of HIV‐psychotic patients.

Psychopharmacologic treatment of patients with HIV/AIDS

“…Clozapine was effective and generally safe in treating HIV-associated psychosis (including negative symptoms) in patients with prior drug-induced parkinsonism [55]. However, clozapine must be used with caution in HIVinfected patients due to the risk of agranulocytosis, and it is contraindicated with ritonavir.…”

Neurotoxicity and dysfunction of dopaminergic systems associated with AIDS dementia

“…The interactions of DA with HIV seem rather complex and poorly understood since melanin produced by spontaneous oxidation of DA may inhibit HIV replication (Montefiori et al, 1990). Recently, clozapine, an atypical antipsychotic that does not block striatal DA receptors, has been shown to be effective in treating psychosis and reversing some of the Parkinsonian features in patients with HIV infection (Lera and Zirulnik, 1999). Clozapine is an atypical antipsychotic that displays low affinity for D 4 receptors, unlike typical antipsychotic agents whose efficacy approximates the affinity for D 2 receptors.…”

Neuropsychiatric Aspects of Infectious Diseases

“…Agents reported in the literature include haloperidol (mean dose, 3 mg), 73 clozapine (mean dose, 27 mg/d), 74 risperidone (mean dose, 3.3 mg/d), 75 and olanzapine (10–15 mg/d). 76 Haloperidol was reported to have a high incidence of EPS and caution is encouraged with clozapine because of the risk for agranulocytosis and interaction with ritonavir.…”