Schizophrenia and Related Psychoses

Zincir, Selma Bozkurt

doi:10.1007/978-3-319-92919-4_15

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…Anecdotal evidence on clozapine has reported considerable concentrations in breast milk, risk of agranulocytosis in the infant and potentially delayed speech development low (Pacchiarotti et al, 2016). Based on the current literature, positive safety data are most consistent for olanzapine (Zincir, 2019). Apart from clozapine, other common antipsychotics are rarely associated with adverse events (Uguz, 2016), but monitoring of neurodevelopment and motor abnormalities is warranted due to the limited amount of evidence (McAllister-Williams et al, 2017;NICE, 2014).…”

Section: Breastfeedingmentioning

confidence: 99%

Antipsychotic medication for women with schizophrenia spectrum disorders

et al. 2021

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There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.

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