Prescribing trends and safety of clozapine in an older persons mental health population

Abstract

Objectives:To provide additional data concerning the safety, effectiveness and local prescribing trends of clozapine in elderly patients.Design:Retrospective observational case-series analysis.Setting:Data were collected from the medical files of 167 patients prescribed clozapine.Participants:All patients prescribed clozapine in the last 15 years by the psychogeriatric service in Christchurch, New Zealand. The subjects were mostly aged over 65; however, patients under 65 are also accepted into the service on a case by case basis if they have an age-related health condition.Results:Twenty-five (15.0%) patients had their clozapine stopped due to a significant adverse reaction, including eleven who developed significant neutropenia. Seventy-four (44.3%) of the patients had no recorded side effects at all. Sixty-five (38.9%) of our elderly patients died while taking clozapine, though none of these deaths was felt to be related to clozapine use. Several patients safely initiated clozapine in either their own home or a nursing home without requiring hospital admission. Only two patients ceased clozapine due to ineffectiveness, and one hundred, forty-two (86.1%) of the patients had positive comments in their medical record regarding the benefits of clozapine for their particular case.Conclusions:We found clozapine could be used safely and effectively in our patient group, for a wider range of indications and at lower doses than younger patients. Data collection regarding cause of death in elderly patients who were ever prescribed clozapine was problematic, and more research into this area is required.

Increased risk of death compared to other antipsychotics in elderly clozapine users in Poland

“…There are data showing the possibility of good tolerability and effectiveness of clozapine in the elderly population in various diagnoses (Law and Croucher, 2019). However, the authors emphasize the fact that this drug is used in lower doses than in younger patients.…”

“…However, the authors emphasize the fact that this drug is used in lower doses than in younger patients. Determining the exact causes of deaths in the studied population also turned out to be problematic (Law and Croucher, 2019).…”

Strategies to Prevent Elderly Suicide: A Delphi Consensus Study

“…Despite the evidence, the utilization of these strategies in older adults is very low in NZ. [21,22] Finally, of the agreed strategies, few are specific to suicide prevention in older adults, reflecting the paucity of age-specific evidence-based interventions. The Table 1.…”

Agranulocitosis inducida por clozapina

“…Encontraron una incidencia conjunta de agranulocitosis y neutropenia del 6,58 %. Concluyeron que clozapina podría usarse de manera segura y eficaz a dosis bajas en este grupo poblacional (20) .…”

“…A la fecha, los estudios farmacogenéticos que evalúan, en primer lugar, la eficacia o respuesta clínica a clozapina se han centrado en las variaciones en los genes relacionados con la farmacocinética o metabolismo de clozapina (a nivel de la familia de enzimas del citocromo P450 y CYP) y los genes relacionados con su farmacodinamia (a nivel de receptores dopaminérgicos y serotoninérgicos). En segundo lugar, los estudios farmacogenéticos que evalúan Autor Inada et al (17) Steinauer et al (18) Tunsirimas et al (19) Law y Croucher (20) la seguridad relacionada a la agranulocitosis se enfocan en las variantes genéticas en los genes dentro de la región del complejo principal de histocompatibilidad (MHC) o, más específicamente, en los genes del HLA (23) .…”