A Questionnaire-based Study of the Views of Schizophrenia Patients and Psychiatric Healthcare Professionals in Japan about the Side Effects of Clozapine

Takeuchi, Ippei; Hanya, Manako; Uno, Junji; Amano, Yuhei; Fukai, Keiko; Fujita, Kiyoshi; Kamei, Hiroyuki

doi:10.9758/cpn.2016.14.3.286

Cited by 12 publications

(11 citation statements)

References 18 publications

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“…In this study, the population of patients was a similar size to clozapine-related studies reported in the literature. In addition, this study group had similar characteristics to those in other related studies [ 2 , 5 , 10 , 21 , 22 , 23 ]. There were more males than females, with a mean age of 44 years, taking a mean dose of 350 (±136) mg of clozapine per day.…”

Section: Discussionsupporting

confidence: 53%

“…Whilst clozapine-induced agranulocytosis is the main fear with treatment, and is the main reason for intensive monitoring, recent evidence from pharmacovigilance databases suggests that GI complications (constipation, intestinal obstruction and paralytic ileus) are the leading cause of clozapine-related deaths [ 32 ]. Clozapine-induced constipation ranges from 14% to 60% [ 23 , 33 ]. In this study, over a fifth of the population suffered with constipation (21.4%).…”

Section: Discussionmentioning

confidence: 99%

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Clozapine Patients at the Interface between Primary and Secondary Care

et al. 2018

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Patients receiving clozapine must undergo routine blood monitoring to screen for neutropenia, and to monitor for potential agranulocytosis. In Cork University Hospital, Cork, Ireland, clozapine is dispensed in the hospital pharmacy and the pharmacists are not aware of co-prescribed medicines, potentially impacting upon patient safety. The aim of this study was to examine the continuity of care of patients prescribed clozapine. A retrospective audit was conducted on patients attending the clozapine clinic at Cork University Hospital and assessed patients’ (i) independent living, (ii) co-prescribed medicines and (iii) knowledge of their community pharmacists regarding co-prescribed clozapine. A list of prescribed medicines for each patient was obtained, and potential drug-drug interactions between these medicines and clozapine were examined using Lexicomp® and Stockley’s Interaction checker. Secondary outcomes included patients’ physical health characteristics, and a review of co-morbidities. Data were collected between the 29 May 2017 and 20 June 2017. Local ethics committee approval was granted. Patients were eligible for inclusion if they were receiving clozapine treatment as part of a registered programme, were aged 18 years or more, and had the capacity to provide written informed consent. Microsoft Excel was used for data analysis. Of 112 patients, (33% female; mean age (SD) 43.9 (11.3) years; 87.5% living independently/in the family home) 86.6% patients reported that they were taking other prescribed medicines from community pharmacies. The mean (SD) number of co-prescribed medicines in addition to clozapine was 4.8 (4) per patient. Two thirds of community pharmacists were unaware of co-prescribed clozapine. Interactions with clozapine were present in all but 3 patients on co-prescribed medicines (n = 97). Lexicomp® reported 2.9 drug-drug interactions/patient and Stockley’s Interaction Checker reported 2.5 drug-drug interactions/patient. Secondary outcomes for patients included BMI, total cholesterol, and HbA1c levels, which were elevated in 75%, 54% and 17% respectively. Patients prescribed clozapine did not receive a seamless service, between primary and secondary care settings. Community pharmacists were not informed of clozapine, prescribed for their patients, in two thirds of cases. Patients in this study were exposed to clozapine-related drug-drug interactions and hence potential adverse effects. This study supports reports in the literature of substandard management of the physical health of this patient group. This study shows that there is an opportunity for pharmacists to develop active roles in the management of all clozapine-related effects, in addition to their traditional obligatory role in haematological monitoring. This study supports the need for a clinical pharmacist to review inpatients commencing on clozapine, monitor for drug-drug interactions and provide counselling.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Clozapine Patients at the Interface between Primary and Secondary Care

et al. 2018

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“…Contrasting with the limited literature on knowledge about clozapine, several studies investigated users' attitudes towards the benefits and risks of clozapine treatment. The positive view of most users about its benefits and advantages compared with prior antipsychotics is a consistent finding across surveys (31)(32)(34)(35)37,41,43,45). Comparable attitudes were found in relatives of clozapine users (34,36).…”

Section: Studies On Educational Needsmentioning

confidence: 68%

“…The characteristics of the studies are described in Table 1. Most studies were carried out in psychiatric hospitals (n = 9) (25,(32)(33)(34)(35)(36)(37)(38)(39). Other mental health settings were community mental health structures (n = 4) (40-43) and clozapine out-patient clinics (n = 3) (26,31,44).…”

Section: Studies On Educational Needsmentioning

confidence: 99%

“…Users reported more side-effects with clozapine than with other antipsychotics (45), and those effects were considered as a major barrier to use by patients with TRS with no prior clozapine treatment (38). Across studies, the most frequently reported adverse effects were salivation, sedation, weight gain and constipation (19,(33)(34)(35)(36)(37)41,43,45). Those considered as the most severe were salivation, weight gain and polyuria (41).…”

Section: Studies On Educational Needsmentioning

confidence: 99%

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Educational needs and psychoeducation interventions in clozapine users: a narrative review

Verdoux

Quilès

2020

Acta Psychiatr Scand

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Verdoux H, Quiles C. Educational needs and psychoeducation interventions in clozapine users: a narrative review. Objective: Increasing users' knowledge about the expected benefits and risks of clozapine may contribute to the initiation and maintenance of clozapine in persons with treatment-resistant schizophrenia (TRS). The objective was to identify the educational needs of clozapine users and the interventions aimed at addressing these needs. Method: We systematically searched multiple electronic databases for articles: (i) exploring educational needs of clozapine users and of their relatives; and (ii) reporting educational interventions aimed at addressing these needs. Data were synthesized narratively. Results: A total of 30 articles published from 1990 to 2019 in 8 countries fulfilled our inclusion criteria. As most studies on educational needs (n = 18) were carried out in persons already taking clozapine, educational needs of TRS patients who were candidates for clozapine treatment are not well documented. Users' level of knowledge about clozapine was often poor, especially about adverse effects or interactions with other substances, with a poor retention of information delivered at treatment initiation. Among 12 studies reporting educational interventions in clozapine users, five provided quantitative outcomes. Their findings suggest that structured educational programmes may contribute to promote clozapine initiation and to improve users' knowledge about this drug. Conclusion: The literature is sparse on structured educational interventions about clozapine, and only one randomized controlled trial was identified. A promising strategy emerging from this review may be staging educational interventions according to the evolving needs of persons with TRS before clozapine use, at initiation and during maintenance treatment.

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