A qualitative exploration of clozapine prescribing and monitoring practices in the Arabian Gulf countries

Ismail, Dalia; Tounsi, Karawen; Zolezzi, Monica; Eltorki, Yassin

doi:10.1016/j.ajp.2018.12.011

Cited by 22 publications

(29 citation statements)

References 22 publications

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“…The presence of contraindications to clozapine in individual patients, as well as the reluctance of some patients to take it (given the mandatory blood monitoring), may explain a portion of the underuse. Still, the resistance of the psychiatrists themselves towards prescribing clozapine likely accounts for most of the underuse, worldwide [28], as well as in the Arabian Gulf region [29]. The low rate of clozapine use in Qatar, contrasting with the high rate of use of two or even more APs, also suggests that AP polypharmacy is likely used as an alternative to clozapine, despite the absence of evidence to support this practice [30].…”

Section: Type and Dose Of Antipsychotics Prescribedmentioning

confidence: 99%

Patterns of prescription of antipsychotics in Qatar

et al. 2020

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Objective Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This study aimed to examine the prescription patterns of antipsychotics in Qatar, in comparison with the international guidelines, and to scrutinize the sociodemographic and clinical features associated with antipsychotic polypharmacy. Methods All the medical records of all the inpatients and outpatients treated by antipsychotics at the Department of Psychiatry–Hamad Medical Corporation (HMC) in Doha, Qatar (between October 2012 and April 2014) were retrospectively analyzed. We retrieved the available sociodemographic data, psychiatric features, and details on the medication history. Results Our sample consisted of 537 individuals on antipsychotics (2/3 were male; mean age 33.8±10.2 years), prescribed for a psychotic disorder in 57%, a mood disorder in 9.3%, and various other diagnoses in 33.7%. About 55.9% received one antipsychotic, 29.6% received two antipsychotics, and 14.5% received more than two antipsychotics. Polypharmacy was associated with younger age (p = 0.025), being single (p<0.001), the diagnosis of a psychotic disorder (p<0.001), and previous admissions to psychiatry (p<0.001). Conclusions Antipsychotic polypharmacy appears to be quite common in Qatar, as it is the case in many other countries, in contrast with most international recommendations. Studies are needed to explore the reasons behind this disparity.

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Section: Type and Dose Of Antipsychotics Prescribedmentioning

confidence: 99%

Patterns of prescription of antipsychotics in Qatar

et al. 2020

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“…Most clozapine registries have specific guidelines as of the monitoring of neutropenia/agranulocytosis, so we recommend that local‐specific recommendations are followed. Large variations exist between countries in the monitoring recommendations , and some countries lack of registries and neutrophil count monitoring recommendation . Prescribers in countries without local monitoring guidelines should refer to schedules recommended by the registries of countries with similar ethnic composition, given the differences between ethnicities in monitoring requirements.…”

Section: From Research To Clinical Practice: When and How To Prescribmentioning

confidence: 99%

How and when to use clozapine

Rubio

Kane

2019

Acta Psychiatr Scand

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Objective Clozapine is the only approved strategy for treatment‐resistant schizophrenia, although it is highly underutilized. We aim to generate practical and actionable evidence‐based recommendations for the use of this drug considering prescription barriers. Method Narrative review. Results A consistent body of evidence supports the efficacy of clozapine reducing morbidity and mortality in schizophrenia. The main obstacles to its use are the lack of experience by prescribers and perceived treatment burden. Systematic screening of eligibility, utilization of available resources for consultation, developing a professional network with other stakeholders, as well as optimizing how clozapine is presented to patients is discussed. Furthermore, specific evidence‐based recommendations for initiation, maintenance, and safety monitoring with clozapine are provided. Conclusion Clozapine prescription is one of the areas in psychiatry with the greatest mismatch between efficacy and utilization in clinical practice. Although multiple barriers to the use of clozapine exist, some of these may be overcome by updates of routine clinical practice.

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“…Furthermore, discontinuation of clozapine is common owing to nonadherence to monitoring protocols or drug-related side effects (Krivoy et al, 2011;Mustafa et al, 2014). Such clinical challenges may be the reason behind the underutilisation of clozapine in Saudi Arabia and other Gulf countries (Ismail et al, 2019). One method of addressing these clinical concerns is therapeutic drug monitoring (TDM), which is the practice of measuring drug levels in the patient's blood to adjust prescribed doses (Kang and Lee, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Such clinical challenges may be the reason behind the underutilisation of clozapine in Saudi Arabia and other Gulf countries [9]. One method of addressing these clinical concerns is therapeutic drug monitoring (TDM), which is the practice of measuring drug levels in the patient's blood to adjust prescribed doses [10].…”

Section: Introductionmentioning

confidence: 99%

Factors predicting serum clozapine levels in Middle Eastern patients: an observational study

Errasoul

Alarabi

2022

Preprint

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Objectives: Despite its superiority over other drugs for psychosis, clozapine remains underused and is associated with many clinical challenges, including difficulties in predicting serum levels. We thus investigated the clinical predictors of clozapine serum levels in Middle Eastern patients. Methods: This was a cross-sectional study including 94 patients of Middle Eastern ethnicity. Results: The average clozapine dose and serum level were 400 mg/daily and 705 ng/mL, respectively. Clozapine dose and serum levels were positively correlated (rs [94]=0.32, p=0.002). A predictive model of serum clozapine levels revealed that the daily dose, smoking status, use of fluvoxamine or lamotrigine, and body mass index predicted 43.6% of the variance in serum levels (p<0.001). Using this model, the maximum doses of clozapine to avoid levels above the optimal range (>650 ng/mL) were 300, 250, or 225 mg/day for non-smokers with a body mass index of 25, 30, or 35 kg/m2, respectively, and 475, 425, or 400 mg/day for smokers with a body mass index of 25, 30, or 35 kg/m2, respectively. Conclusions: These findings do not reduce the value of individualised therapeutic drug monitoring but may assist clinicians when prescribing clozapine to Middle Eastern patients. Further psychopharmacological studies are needed on this demographic population.

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A qualitative exploration of clozapine prescribing and monitoring practices in the Arabian Gulf countries

Cited by 22 publications

References 22 publications

Patterns of prescription of antipsychotics in Qatar

Patterns of prescription of antipsychotics in Qatar

How and when to use clozapine

Factors predicting serum clozapine levels in Middle Eastern patients: an observational study

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