Clinical Evaluation and Plasma Clozapine Concentrations in Chinese Patients With Schizophrenia

Chong, Siow‐Ann; Tan, C.H.; Khoo, Yok Moi; Lee, How-Sung; Wong, KokSheik; Ngui, F.; Winslow, Munidasa

doi:10.1097/00007691-199704000-00018

Cited by 56 publications

(55 citation statements)

References 15 publications

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“…38 In another study, the akathisia scores, as measured by the Simpson-Angus scale, did not significantly improve from baseline in clozapine-treated Asian patients. 39 In contrast, in the present study olanzapinetreated Japanese patients showed significant improvement from baseline (P < 0.001, data not shown) as well as compared to haloperidol-treated patients on the DIEPSS total score and the akathisia item score, while they were on relatively lower doses of olanzapine compared to their Caucasian counterparts. This suggests that olanzapine therapy is associated with fewer EPS compared to the typical agents and perhaps clozapine for Japanese patients with schizophrenia and possibly for other Asian patients with schizophrenia.…”

Section: Discussioncontrasting

confidence: 90%

Olanzapine versus haloperidol in the treatment of patients with chronic schizophrenia: Results of the Japan multicenter, double‐blind olanzapine trial

Ishigooka¹,

Inada

Miura³

2001

Psychiatry Clin Neurosci

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This randomized double-blind trial was conducted to test the efficacy and safety of olanzapine in Japanese patients with schizophrenia. Importantly, this study also represents the first large clinical trial of olanzapine conducted in an Asian population. Patients (n = 182) were randomly assigned to treatment with olanzapine or haloperidol over a period of 8 weeks. The primary analyses included: (i) a test of non-inferiority of olanzapine compared with haloperidol in efficacy using the Final Global Improvement Rating (FGIR); and (ii) comparison between the treatment groups in extrapyramidal symptom severity using the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). Olanzapine was comparable to haloperidol in efficacy in treating positive symptoms and significantly superior in treating negative symptoms. Extrapyramidal symptom severity was significantly improved for olanzapine-treated patients versus haloperidoltreated patients. Olanzapine was shown to be more effective and better tolerated than haloperidol in the treatment of Japanese patients suffering from chronic schizophrenia.

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Section: Discussioncontrasting

confidence: 90%

Olanzapine versus haloperidol in the treatment of patients with chronic schizophrenia: Results of the Japan multicenter, double‐blind olanzapine trial

Ishigooka¹,

Inada

Miura³

2001

Psychiatry Clin Neurosci

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“…Polymorphisms in the cytochrome P450 2D6 (CYP2D6) gene are a major cause of pharmacokinetic variability in humans, and sufficient evidence suggests ethnic differences in the metabolism of antipsychotics between Asian and western populations [54,55]. For instance, fluoxetine and paroxetine, which are potent CYP2D6 inhibitors, will raise aripiprazole blood levels and thus a lower dose might be used in clinical practice.…”

Section: Clinical Issues In the Use Of Atypical Antipsychotics In CLImentioning

confidence: 99%

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Pae

Patkar

2013

CNS Drugs

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Major depressive disorder (MDD) is a chronic, recurrent mental disease that causes serious disability. Because currently available antidepressants have limited efficacy with respect to response and remission in patients with MDD, clinicians must choose the best available treatment interventions for patients who do not respond to initial antidepressant treatment. The existing literature demonstrates that augmentation with atypical antipsychotics (AAs) shows higher response and remission rates compared with antidepressant monotherapy, but is associated with more withdrawals due to adverse events. In this paper, specific clinical issues in the use of AA augmentation for patients with MDD are briefly discussed. Given the limited information and clinical knowledge on the proper and effective use of AAs for MDD, future research should focus on practical clinical issues that can be commonly seen in routine practice but have not been addressed yet. This is because the use of AAs is likely to expand as there is good evidence for their effectiveness and tolerability as augmentation therapy for patients with MDD.

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“…[22][23] Thus Chinese patients may be more sensitive to rapid clozapine titration, as compared with Caucasians. Clozapine metabolism was also found to be affected by concomitant use of valproate, although the results had been contradicting.…”

Section: The Incidence and Characteristics Of Clozapine-induced Fevermentioning

confidence: 99%

The Incidence and Characteristics of Clozapine-Induced Fever in a Local Psychiatric Unit in Hong Kong

et al. 2008

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Objective: To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit. Method: A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever. Results: Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8 °C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02). Conclusion: Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.

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Clinical Evaluation and Plasma Clozapine Concentrations in Chinese Patients With Schizophrenia

Cited by 56 publications

References 15 publications

Olanzapine versus haloperidol in the treatment of patients with chronic schizophrenia: Results of the Japan multicenter, double‐blind olanzapine trial

Olanzapine versus haloperidol in the treatment of patients with chronic schizophrenia: Results of the Japan multicenter, double‐blind olanzapine trial

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

The Incidence and Characteristics of Clozapine-Induced Fever in a Local Psychiatric Unit in Hong Kong

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