Common Side Effects and Metabolic Syndrome due to Clozapine: Relationship with the Clinical Variables and Disability

Gürcan, Gamze; Şenol, Şevin Hun; Yağcıoğlu, A. Elif Anıl; Karahan, Sevilay; Ertuğrul, Aygün

doi:10.5080/u25737

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…Among Clozapine's adverse effects targeting the central nervous system (CNS), sedation is the most frequent, with an incidence varying from 10% to 58% and, according to few studies, sometimes reaching up to 90% of the patients treated [55, 179,[186][187][188]. Similarly, dizziness is common and related to its metabolite's (norclozapine) plasma levels [189].…”

Section: Central Nervous Systemmentioning

confidence: 99%

Rethinking Clozapine: Lights and Shadows of a Revolutionary Drug

Dell’Osso,

Bonelli,

Nardi

et al. 2024

Brain Sciences

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The current literature globally highlights the efficacy of Clozapine in several psychiatric disorders all over the world, with an FDA indication for reducing the risk of repeated suicidal behavior in patients with schizophrenia or schizoaffective disorder. A growing field of research is also stressing a possible broader beneficial effect of Clozapine in promoting neuroprotection and neurotrophism. However, this drug is linked to several life-threatening side effects, such as agranulocytosis, myocarditis and seizures, that limit its use in daily clinical practice. For this work, a search was performed on PubMed using the terms “Clozapine indications”, “Clozapine adverse effects”, “Clozapine regenerative effects”, and “Clozapine neuroplasticity” with the aim of reviewing the scientific literature on Clozapine’s treatment indications, adverse effects and potential regenerative role. The results confirmed the efficacy of clozapine in clinical practice, although limited by its adverse effects. It appears crucial to raise awareness among clinicians about the potential benefits of using Clozapine, as well educating medical personnel about its risks and the early identification of possible adverse effects and their management.

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Section: Central Nervous Systemmentioning

confidence: 99%

Rethinking Clozapine: Lights and Shadows of a Revolutionary Drug

Dell’Osso,

Bonelli,

Nardi

et al. 2024

Brain Sciences

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“…368,373 Sedation Clozapine-induced sedation (CIS) ranks among the most commonly reported side-effects. 189,[374][375][376] It shows a clear dose dependence, but is often at least partly transient. 88,190,234,377 Importantly, while there are established protocols regarding other important side-effects, data regarding the management of CIS remain limited, despite the relevance of CIS as a key determinant of treatment adherence.…”

Section: Gastrointestinal Side Effectsmentioning

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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“…Individuals on long-term clozapine report sedation as the one of the most disturbing adverse effects, apart from hypersalivation and constipation (Gurcan 2021). It is also one of the most common reasons patients give for discontinuation of clozapine (Legge 2016).…”

Section: Prevalence and Impactmentioning

confidence: 99%

Management of sedation due to clozapine

Gupta

Parkinson²

2022

BJPsych advances

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SUMMARY Sedation is one of the most common adverse effects of clozapine. Although tolerance develops to some extent, a significant proportion of patients continue to experience sedation and associated negative consequences on their quality of life. Sedation is also one of the most common reasons for the discontinuation of clozapine and it is therefore important to proactively manage it. This article provides brief guidance for clinicians.

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Common Side Effects and Metabolic Syndrome due to Clozapine: Relationship with the Clinical Variables and Disability

Cited by 3 publications

References 28 publications

Rethinking Clozapine: Lights and Shadows of a Revolutionary Drug

Rethinking Clozapine: Lights and Shadows of a Revolutionary Drug

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

Management of sedation due to clozapine

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