Metabolic Disturbances, Side Effect Profile and Effectiveness of Clozapine in Adolescents

Grover, Sandeep; Hazari, Nandita; Chakrabarti, Subho

doi:10.4103/0253-7176.183091

Cited by 15 publications

(6 citation statements)

References 33 publications

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“…Furthermore, some populations, that is the elderly or adolescents, may be particularly vulnerable to clozapine adverse effects despite its proven efficacy. 36–38…”

Section: Clozapine Mechanism Of Action and Relationships With Adversementioning

confidence: 99%

Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

Berardis¹,

Rapini²,

Olivieri³

et al. 2018

Therapeutic Advances in Drug Safety

147

125

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Clozapine, a dibenzodiazepine developed in 1961, is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. Since its introduction, it has remained the drug of choice in treatment-resistant schizophrenia, despite a wide range of adverse effects, as it is a very effective drug in everyday clinical practice. However, clozapine is not considered as a top-of-the-line treatment because it may often be difficult for some patients to tolerate as some adverse effects can be particularly bothersome (i.e. sedation, weight gain, sialorrhea etc.) and it has some other potentially dangerous and life-threatening side effects (i.e. myocarditis, seizures, agranulocytosis or granulocytopenia, gastrointestinal hypomotility etc.). As poor treatment adherence in patients with resistant schizophrenia may increase the risk of a psychotic relapse, which may further lead to impaired social and cognitive functioning, psychiatric hospitalizations and increased treatment costs, clozapine adverse effects are a common reason for discontinuing this medication. Therefore, every effort should be made to monitor and minimize these adverse effects in order to improve their early detection and management. The aim of this paper is to briefly summarize and provide an update on major clozapine adverse effects, especially focusing on those that are severe and potentially life threatening, even if most of the latter are relatively uncommon.

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“…Furthermore, some populations, that is the elderly or adolescents, may be particularly vulnerable to clozapine adverse effects despite its proven efficacy. 36–38…”

Section: Clozapine Mechanism Of Action and Relationships With Adversementioning

confidence: 99%

Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

Berardis¹,

Rapini²,

Olivieri³

et al. 2018

Therapeutic Advances in Drug Safety

147

125

View full text Add to dashboard Cite

show abstract

“…Olanzapine was found to have the greatest weight gain, followed by risperidone and haloperidol (5.1, 4.1, and 2.8 kg), respectively ( 6 ). Though other factors contribute to the onset of metabolic changes, clozapine use contributed largely, as after starting clozapine the prevalence of metabolic syndrome increased from 23 to 38.5% and after 6 months increased to 46.2% ( 12 ). A study from north India indicates that obstructive sleep apnoea may be a mediating factor for metabolic syndrome with persons on second generation antipsychotics ( 14 ).…”

Section: Resultsmentioning

confidence: 99%

Cardiovascular Diseases and Schizophrenia in India: Evidence, Gaps, and Way Forward

et al. 2021

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Background: The importance of physical health among persons with schizophrenia is well-established. Studies from developed and developing countries indicated a strong association between cardiovascular diseases and schizophrenia, while evidence from India is scattered and in its infancy. Hence, the aims of the study were to collate available studies from India on cardiovascular diseases among persons with schizophrenia, identify knowledge gaps and challenges, and discuss recommendations to improve clinical care and research on cardiovascular diseases among persons with schizophrenia in India.Materials and methods: A comprehensive literature review of Indian studies on cardiovascular diseases and schizophrenia was conducted to collate and synthesise available knowledge.Results: Several risk factors for cardiovascular disease predominated among persons with schizophrenia. Metabolic syndrome and obesity were the key factors that were reported. Knowledge gaps were identified with respect to the prevalence of cardiovascular diseases among persons with schizophrenia. Sparse research in interventions to prevent and reduce the impact of cardiovascular diseases among persons with schizophrenia was noted.Conclusion: Targeted efforts are needed at the clinic, community, and policy levels to understand the impact of cardiovascular diseases among persons with schizophrenia. Robust and feasible interventions targeting cardiovascular diseases and its varied risk factors in persons with schizophrenia, that can be implemented in tertiary mental health services, need to be developed and tested.

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“…Wysokiński (2014) in his research involving 24 patients who used clozapine and 24 patients in control group, reports that the blood glucose level of the patients who used clozapine are higher than the control group (103.5±31.6 vs 87±811.7 mg/dl, p=0.04). Further, Grover et al (2016) report that an increase in blood glucose is happened after using clozapine for three months, 80.92±9.95 mg/dl becomes 88.08±11.6 mg/dl.…”

Section: The Increase In Abdominal Circumferencementioning

confidence: 94%

The Increased Risk of Random Blood Glucose, Body Mass Index and Abdominal Circumference in the Schizophrenic Patients Using Clozapine and Quetiapine

Hidayah¹,

Darmawan²,

Yuliani³

2022

COMORBID

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The use of atypical antipsychotics often causes an increase in blood glucose levels, body mass index (BMI) and abdominal circumference. This study aims to identify the increased risk of random blood glucose, BMI and abdominal circumference in the schizophrenic patients using clozapine and quetiapine. This cohort study involved 35 schizophrenic patients (19 patients used clozapine and 16 patients used quetiapine). The measurement of random blood glucose BMI and abdominal circumference was done in the zero month, the first month and the second month. The average of random blood glucose, BMI and abdominal circumference were analyzed using Wilcoxon and Chi-square. In the use of clozapine, there is a significant increase in the average of random blood glucose between the first month and the second month (p=0.1) with the difference of 6.37 mg/dl, there is an increase average in BMI between the first month and the second month (p=0.03) with the difference of 0.18 kg/m² and an average increase in abdominal circumference between the zero month and the first month (p=0.04) with the difference of 1.47 cm, between the first month and the second month (p=0.02) with the difference of 1.94 cm. In the use of quetiapine, a significant increase in abdominal circumference between the first month and the second month (p=0.02) with the difference 1.38 cm. The use of clozapine has more risk in increasing random blood glucose (OR 2.00: CI 95% 0.41-9.76), BMI (OR 2.78: CI 95% 0.69-11.10) and abdominal circumference (OR 3.61: CI 95% 0.89-14.64) compared to the use of quetiapine. The use of clozapine has more risk in increasing blood glucose, BMI and abdominal circumference compared to the use of quetiapine.

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Metabolic Disturbances, Side Effect Profile and Effectiveness of Clozapine in Adolescents

Cited by 15 publications

References 33 publications

Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

Cardiovascular Diseases and Schizophrenia in India: Evidence, Gaps, and Way Forward

The Increased Risk of Random Blood Glucose, Body Mass Index and Abdominal Circumference in the Schizophrenic Patients Using Clozapine and Quetiapine

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