Clozapine and hematologic adverse reactions: Impact of the Risk Evaluation and Mitigation Strategy program

Borrelli, E.; Lee, Erica Y.; Caffrey, Aisling R.

doi:10.9740/mhc.2020.05.070

Cited by 9 publications

(4 citation statements)

References 21 publications

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“…Otro hallazgo relevante es el uso de clozapina en 8,7% de pacientes, pues su indicación además de pacientes con esquizofrenia resistentes al manejo convencional (26) , involucra a los pacientes con TB refractario, de allí su uso en este grupo. No obstante, llama la atención que sólo fuese empleada en monoterapia, lo que genera dudas acerca de su indicación en pacientes que no respondieron al tratamiento de primera línea (20) , pero siempre teniendo en consideración que su uso se puede asociar a reacciones adversas severas que incluyen aplasia medular, agranulocitosis, trombocitopenia, y que debería acompañarse también de pruebas de laboratorio para hacer seguimiento y monitoreo de su toxicidad (27) .…”

Section: Discussionunclassified

Con qué medicamentos están siendo tratados los pacientes con trastorno afectivo bipolar en Colombia

et al. 2023

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Introducción: El trastorno bipolar (TB) es una condición psiquiátrica grave caracterizada por alteraciones progresivas en las funciones sociales y cognitivas. Objetivo: Determinar cuáles son los medicamentos con que se está tratando a un grupo de pacientes con diagnóstico de TB, afiliados al Sistema de Salud de Colombia. Materiales y métodos: Estudio de corte para identificar prescripciones de medicamentos de pacientes ambulatorios de cualquier edad y sexo con TB, a partir de una base de datos poblacional de dispensaciones. Se consideraron variables sociodemográficas, clínicas y farmacológicas buscando medicamentos en indicaciones aprobadas y no aprobadas por agencias reguladoras. Resultados: Se identificaron 1334 pacientes, con edad media de 40,2±18,5 años y 50% eran mujeres. Un total de 809 (60,6%) pacientes eran tratados en monoterapia principalmente con ácido valproico (286/615 pacientes, 46,4%), quetiapina (259/525, 49,3%) y Carbonato de Litio (98/275, 35,6%). Las combinaciones más comunes de fármacos para su tratamiento fueron ácido valproico más quetiapina (n=162, 12,1%), ácido valproico más risperidona (n=73, 5,5%) y carbonato de litio más quetiapina (n=62, 4,6%). El 57,4% (n=766) tenían prescripciones de fármacos con indicaciones no aprobadas. Conclusiones: Los pacientes con TB son tratados principalmente en monoterapia y más de la mitad estaba recibiendo fármacos en indicaciones no aprobadas.

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Section: Discussionunclassified

Con qué medicamentos están siendo tratados los pacientes con trastorno afectivo bipolar en Colombia

et al. 2023

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“…the Drooling severity scale or Nocturnal Hypersalivation Rating Scale 374,375  Sugar free chewing gum during the day; elevation of upper body during the night 375  Pirenzepine (25-100 mg/d); Cave: anticholinergic load 16, 91,371  Alternative options: atropine drops s.l., ipratropium bromide s.l. 371  Botulinumtoxin injection (incobotulinum toxin A) into the parotid and submandibular glands 16,260,264,373,[376][377][378] Qubad & Bittner -Clozapine treatment in schizophrenia Constipation, CIGH* 385,386  Regular clinical assessment 91,98,146  Physical activity, sufficient fluid intake, fiber-rich diet 16,91,214,215  Discontinue non-essential drugs that increase anticholinergic load 212,213  Treatment with laxatives [214][215][216] Qubad & Bittner -Clozapine treatment in schizophrenia 34 Hematological side effects 148,156  Complete differential blood count: at baseline, once weekly (1 st -18 th week), then monthly; in case of discontinuation continue monitoring for four weeks 72,91,387  Leukopenia (white blood cells (WBC) < 4/nl) vs. CIN (ANC < 1,5/nl) vs. CIA (ANC < 0,5/nl) 72, [387][388][389] o In Cases of WBC 3-3,5/nl and ANC 1,5-2/nl:…”

Section: Cyp Inducers Cyp Inhibitorsmentioning

confidence: 99%

Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia

Qubad

Bittner

2023

Therapeutic Advances in Psychopharmacology

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Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine’s wide-ranging superior efficacy – for treatment-resistant schizophrenia (TRS) and beyond – and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients’ benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine’s unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine’s full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.

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Section: Cyp Inducers Cyp Inhibitorsmentioning

confidence: 99%

Second to None – Rationale, Timing, and Clinical Management of Clozapine Use in Schizophrenia

Qubad¹,

Bittner²

2022

Preprint

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Despite its continued relevance as the single most effective and important evidence-based treatment for schizophrenia, the degree of underutilization of clozapine across health systems remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to use clozapine due to its relatively large side-effect burden and its comparatively complex dosing and monitoring requirements. This underscores the necessity for continued education of clinicians in the intricacies of clozapine use and in the still growing case in favor of this vital treatment option. Consequently, this narrative review provides a comprehensive outline of all lines of evidence, which support clozapine’s wide-ranging superior efficacy, and of the current knowledge regarding the prevalence and diagnosis of treatment resistance. The distinct neurobiological and clinical characteristics of this condition makes the swift initiation of clozapine indispensable. Moreover, we review the extensive literature regarding clozapine’s side effect profile and current recommendations for optimal treatment and monitoring algorithms including for particularly vulnerable populations such as elderly patients and pregnant women and for potential re-challenges after myocarditis and neutropenia. We also discuss established approaches to increase treatment response as well as augmentation strategies for patients with partial or full clozapine resistance. We argue for a clear focus on early and consistent detection and management of side effects, which can ensure patient safety and reduce permanent all-cause discontinuation. This strategy needs to be combined with a long-term approach acknowledging the late onset of clozapine’s full advantageous effects, which – in cases like reduced mortality rates – even then may not be easily discernible. Our aim is to encourage a safer, more frequent, and timely use of clozapine to maximize patients’ short- and long-term benefits. Even now, the extent of these benefits as well as patient’s satisfaction with treatment still clearly set clozapine apart from all other available treatment options.

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Clozapine and hematologic adverse reactions: Impact of the Risk Evaluation and Mitigation Strategy program

Cited by 9 publications

References 21 publications

Con qué medicamentos están siendo tratados los pacientes con trastorno afectivo bipolar en Colombia

Con qué medicamentos están siendo tratados los pacientes con trastorno afectivo bipolar en Colombia

Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia

Second to None – Rationale, Timing, and Clinical Management of Clozapine Use in Schizophrenia

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