Optimizing clozapine treatment

Abstract

Treatment with clozapine should be optimized in order to increase the rate of response and to minimize side-effects, thus diminishing the risk of discontinuation and psychotic relapse.

Clozapine-Induced Myocarditis: Prevention and Considerations in Rechallenge

“…In addition, there is a small body of literature suggesting that valproate can increase the risk of developing myocarditis. 7 While no dose relationship has been established in connection with serious adverse events including myocarditis 8,9 , an interesting aspect of this case is Ms. B's markedly elevated clozapine level of 2,211 mcg/L (toxic range is > 1,000 mcg/L).…”

“…Ms. B was not taking any agents known to inhibit CYP1A2. While the clinical utility of routine monitoring of plasma levels of clozapine is controversial, 8 earlier clozapine levels in this case may have been informative and assisted in finding the optimal therapeutic dose.…”

“…While there is conflicting documentation on the speed at which clozapine can safely be titrated, 8 rapid dose titration has been suggested as a factor increasing the risk of clozapine-induced myocarditis . 7 The comparison to the incidence of lamotrigine-associated Stevens-Johnson syndrome which is determined by the rapidity of lamotrigine titration and drug-drug interactions has been suggested.…”

Managing pathologic aggression in people with psychotic disorders

“…[18][19][20][21] To minimize adverse effects and increase response to clozapine, up-titration should be slow, and patients should be treated with the lowest effective dose. 22 Reducing the dose can improve many dose-dependent side effects.…”

Boticarium I

“…A la hora de redactar este comentario estamos a la espera de que se modifiquen las condiciones del programa de farmacovigilancia en vigor desde 1993, lo que, en principio, se traduciría en un aumento del uso del fármaco. Entre tanto, merece la pena reseñar un trabajo de Nielsen et al (11) en el que se plantea cómo "optimizar" el tratamiento con clozapina: duración de la monoterapia, cuándo pedir niveles plasmáticos y en qué rango deben situarse, cómo reducir el impacto de sus abundantes efectos secundarios y cuándo y con qué productos potenciar su acción. En su vertiente negativa, el boletín australiano Medicines Safety Update comenta el riesgo de estreñimiento severo con clozapina y ofrece pautas para su reconocimiento y prevención (12).…”