Rapid clozapine titration in treatment-refractory bipolar disorder

Ifteni, Petru; Correll, Christoph U.; Nielsen, Jimmi; Burtea, Victoria; Kane, John M.; Manu, Peter

doi:10.1016/j.jad.2014.04.020

Cited by 51 publications

(35 citation statements)

References 18 publications

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“…This retrospective study supports the findings of a previous study [5] regarding the safety and effectiveness of rapid clozapine titration in treatment-refractory schizophrenia. We also found that a rapid titration dosing regimen of clozapine was safe in patients who were started on clozapine for he first time and in patients who used previously clozapine.…”

Section: Discussionsupporting

confidence: 90%

“…Seizures are also more common during the early periods of clozapine treatment [4]. However, it has been argued that the longer clozapine titration periods could delay the adequate control of symptoms and prolong the duration of hospital stay, unnecessarily [5]. Significant variations were observed in plasma levels with any given dose, both between individuals (8-45 fold difference) and within individuals (18-53 % variance) [6] which may complicate the prediction of the severity of side effects.…”

Section: Introductionmentioning

confidence: 99%

“…In a recent study, Ifteni et al have shown that rapid clozapine titration was effective and safe in patients with schizophrenia [5]. They also compared rapid with standard titration in patients with treatment-refractory bipolar disorder and found that rapid clozapine titration was equally safe and effective in this patient group [7].…”

Section: Introductionmentioning

confidence: 99%

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Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia

Poyraz¹,

Özdemir

Sağlam³

et al. 2015

Psychiatr Q

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The aim of this study is to evaluate the safety and effectiveness of rapid clozapine titration in patients with schizophrenia in hospital settings. We conducted a retrospective two-center cohort study to compare the safety and effectiveness of clozapine with different titration rates in treatment-refractory patients with schizophrenia. In the first center, clozapine was started at 25-50 mg followed by 50-100 mg as needed every 6 h on day 1, followed by increases of 50-100 mg/day. In the second center, titration was slower; clozapine initiated with 12.5-50 mg on day 1 followed by increases of 25-50 mg/day. The number of days between starting of clozapine until discharge was shorter in the rapid titration group (22.4 ± 8.72 vs 27.0 ± 10.5, p = 0.1). Number of days of total hospital stay were significantly shorter in the rapid titration group (29.6 ± 10.6 vs 41.2 ± 14.8, p = 0.002). Hypotension was more common in the rapid titration group and one patient had suspected myocarditis. Rapid clozapine titration appeared safe and effective. The length of stay following initiation of clozapine was shorter in the rapid-titration group, although this was not statistically significant. However starting clozapine earlier together with rapid titration has significantly shortened the length of hospital stay in patients with treatment refractory schizophrenia.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia

Poyraz¹,

Özdemir

Sağlam³

et al. 2015

Psychiatr Q

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“…23 Nevertheless, and despite the lack of randomized controlled studies, clozapine is used off-label for the treatment of aggression in patients with BD, intermittent explosive disorder, post-traumatic stress disorder mental retardation, manifestations of personality disorder and agitation in dementia. 16,[24][25][26][27][28][29][30][31] Furthermore, clozapine use reduced psychiatric hospitalization and emergency room visits, numbers and length of psychiatric admissions, and psychotropic comedications, in patients with BD. 15,32 …”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] Although clozapine has never been approved for the treatment of bipolar disorder, it has showed efficacy in acute mania with psychosis and for the treatment of refractory symptoms associated with BD. [12][13][14][15][16] The efficacy of clozapine in severe manic patients was reported both as monotherapy and as an add-on strategy. 17 Despite this evidence, clozapine remains underutilized in general 18 and in BD in particular, mostly due to tolerability and safety concerns.…”

Section: Introductionmentioning

confidence: 99%

Switching Bipolar Disorder Patients Treated with Clozapine to Another Antipsychotic Medication: A Mirror Image Study

Ifteni

Teodorescu

2017

Eur. psychiatr.

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Bipolar disorder (BD) is associated with periodic symptom exacerbations, leading to functional impairment, and increased risk of suicide. Although clozapine has never been approved for the treatment of BD, it is occasionally used in severe mania. The aim of the study is to evaluate the risks and benefits of switching clozapine in remitted BD patients. This is an observational, mirror image study of 62 consecutive remitted BD outpatients treated with clozapine. Twenty-five patients were switched to another antipsychotic following a change in a drug reimbursement rule, while 37 continued on clozapine. The mean time in remission was shorter for the switched group (9.2±4 months vs 13±6 months, P=0.018), and the number of patients who relapsed was larger (n=21 vs n=8, P,0.0001). The results suggest that switching from clozapine to another antipsychotic may increase the risk of relapses in remitted patients with BD.

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Neuropsychopharmacotherapy: Differential Dose Regimes in China

Shen

2022

NeuroPsychopharmacotherapy

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Rapid clozapine titration in treatment-refractory bipolar disorder

Cited by 51 publications

References 18 publications

Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia

Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia

Switching Bipolar Disorder Patients Treated with Clozapine to Another Antipsychotic Medication: A Mirror Image Study

Neuropsychopharmacotherapy: Differential Dose Regimes in China

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