Effectiveness and safety of rapid clozapine titration in schizophrenia

Ifteni, Petru; Nielsen, Jimmi; Burtea, Victoria; Correll, Christoph U.; Kane, John M.; Manu, Peter

doi:10.1111/acps.12241

Cited by 44 publications

(34 citation statements)

References 20 publications

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“…Additionally, we hadn't had the opportunity to measure plasma levels of clozapine and norclozapine. Yet our findings suggest that rapid titration can safely be administered when warranted and confirms the previous studies of [5,7].…”

Section: Discussionsupporting

confidence: 90%

“…As stated by Ifteni et al [7], we also believe that the titration rate of clozapine should be determined according to patients' needs in hospital settings. Tolerability of clozapine should be assessed at an individual level.…”

Section: Discussionmentioning

confidence: 84%

“…Ifteni et al [7] reported that they obtained symptom control with an average dose of 372 ± 181 mg/day after 5.1 ± 4.0 days in 111 patients with treatment-refractory schizophrenia and none had seizures, severe hypotension, myocarditis or other major adverse effects. In another report from Australia authors have described a different protocol [10].…”

Section: Discussionmentioning

confidence: 99%

“…Tolerability of clozapine should be assessed at an individual level. As recommended by Ifteni et al [7] dosing every 6 h during the first 24 h might help to determine the tolerability of the patients. We recommend rapid titration of clozapine, after an initial test dose of 25-50 mg, if this is well tolerated 25-50 mg may be further given every 6 h, with a total dose of 100-150 mg in the first day especially in younger patients in whom adequate control of symptoms is urgent.…”

Section: Discussionmentioning

confidence: 99%

“…They also compared rapid with standard titration in patients with treatment-refractory bipolar disorder and found that rapid clozapine titration was equally safe and effective in this patient group [7].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia

Poyraz¹,

Özdemir

Sağlam³

et al. 2015

Psychiatr Q

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The aim of this study is to evaluate the safety and effectiveness of rapid clozapine titration in patients with schizophrenia in hospital settings. We conducted a retrospective two-center cohort study to compare the safety and effectiveness of clozapine with different titration rates in treatment-refractory patients with schizophrenia. In the first center, clozapine was started at 25-50 mg followed by 50-100 mg as needed every 6 h on day 1, followed by increases of 50-100 mg/day. In the second center, titration was slower; clozapine initiated with 12.5-50 mg on day 1 followed by increases of 25-50 mg/day. The number of days between starting of clozapine until discharge was shorter in the rapid titration group (22.4 ± 8.72 vs 27.0 ± 10.5, p = 0.1). Number of days of total hospital stay were significantly shorter in the rapid titration group (29.6 ± 10.6 vs 41.2 ± 14.8, p = 0.002). Hypotension was more common in the rapid titration group and one patient had suspected myocarditis. Rapid clozapine titration appeared safe and effective. The length of stay following initiation of clozapine was shorter in the rapid-titration group, although this was not statistically significant. However starting clozapine earlier together with rapid titration has significantly shortened the length of hospital stay in patients with treatment refractory schizophrenia.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 84%