TY - JOUR. T1 - An association between autumn birth and clozapine treatment in patients with schizophrenia: A population-based analysis. AU - Sørensen, Holger Jelling. AU - Foldager, Leslie. AU - Røge, Rasmus. AU - Pristed, Sofie Gry. AU - Andreasen, Jesper T.. AU - Nielsen, Jimmi. PY - 2014. Y1 - 2014. N2 - Background: Numerous studies on seasonality of birth and schizophrenia risk have been published but it is uncertain whether, among those with schizophrenia, refractory illness exhibits any predilection for birth month. We hypothesized and examined whether a season of birth effect was present in patients with schizophrenia with a history of clozapine treatment. Method: Using record linkage with Danish registers, we examined patients with schizophrenia born between 1950 and 1970, and between 1995 and 2009 and Cox regression analysis was used to examine season of birth in relation to history of clozapine treatment. Results: In a study population corresponding to 60,062 person-years from 5328 ...
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TY - JOUR. T1 - Treating chemotherapy induced agranulocytosis with granulocyte colony-stimulating factors in a patient on clozapine. AU - Kolli, Venkata. AU - Denton, Kevin. AU - Borra, Dileep. AU - Pulluri, Madhuri. AU - Sharma, Ashish. PY - 2013/7/1. Y1 - 2013/7/1. N2 - Background Clozapine is reserved for overcoming treatment resistance in schizophrenia. Malignancy is common in schizophrenia; however, there is limited evidence available on continuing clozapine with chemotherapy, with both having hematological adverse effects. Objective To report a case on the use of granulocyte colony-stimulating factor (G-CSF) in conjunction with clozapine and chemotherapy. Methods We searched PubMed for any available information on the use of granulocyte G-CSF with clozapine and chemotherapy. We report the case of a patient with schizophrenia who developed B-cell lymphoma and was treated with chemotherapy consisting of CHOP regimen, rituximab, and methotrexate. He was continued on clozapine and G-CSF. ...
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Clozapine is known as one of the atypical antipsychotics which is placed in the second line of medical treatment for schizophrenia due to its hematologic complications. It is used in cases of resistance to treatment. Some side effects of clozapine include leukopenia, granulocytopenia, fever, hepatotoxicity, sedation, dizziness, hypotension, weight gain, constipation, and seizure. Neutropenia and hepatotoxicity have been separately reported after taking atypical antipsychotics, including clozapine. However, simultaneous occurrence of these two complications is rare and has not been reported with clozapine use. This study reports a case of concurrent hepatotoxicity and neutropenia induced by clozapine. The patient was a 58-year-old man who started taking clozapine for the first time in March 2017, about seven weeks before his recent admission, because of a history of treatment-resistant schizophrenia. He had been referred to the emergency department of a general hospital with symptoms of weakness,
Clozapine is a dibenzodiazepine antipsychotic used for treatment-resistant schizophrenia. Its association with several side effects such as agranulocytosis, seizure, and insulin resistance is well known. Cardiac side effects such as myocarditis and cardiomyopathy are less common and have been seldom reported. Here we report an unusual case of clozapine-induced nonischemic dilated cardiomyopathy. A 50-year-old female with treatment-resistant schizophrenia on clozapine presented with gradually worsening shortness of breath, productive cough, and pleuritic chest pain. She was found to have non-ischemic dilated cardiomyopathy due to clozapine use as no other causative factor was found. Clozapine was gradually tapered and then discontinued. Repeat echocardiogram in three months revealed improvement in ejection fraction. This case is unique as it outlines clozapine as a rare cause of nonischemic cardiomyopathy, as discontinuation of the drug showed improvement in symptoms and heart function.
Alcohol use disorder is at least three times more common in schizophrenia than in the general population, and worsens the course of schizophrenia. Typical antipsychotic agents are of limited value in controlling alcohol use in these dual diagnosis patients. Data from our group and others suggest that the atypical antipsychotic drug clozapine limits alcohol and cannabis use in dual diagnosis patients with schizophrenia much more effectively than other antipsychotics that have been assessed, however, the side effects produced by clozapine severely limit its use.. The investigators have hypothesized that clozapine will lessen alcohol/substance use in such dual diagnosis patients in part because of its mechanism of action that includes release of dopamine (DA) in the prefrontal cortex which will help to normalize dysfunctional brain reward circuits that may underlie the co- occurring alcohol/substance use in patients with schizophrenia. Our data suggest that the effect of clozapine can be ...
Purpose: Clozapine is a well-known antipsychotic medication licensed for treatment-resistant schizophrenia, but there is limited research available to suggest its efficacy in the context of personality disorder and intellectual disabilities presenting with high-risk behaviour with or without psychotic symptoms. The purpose of this paper is to raise awareness of the benefits of using clozapine in patients with intellectual disabilities and personality disorder that present with a complex picture of serious risk of harm to both their life and the lives of others. Design/methodology/approach: The authors present five patients with intellectual disabilities and serious life-threatening challenging behaviour whom were started on clozapine as part of their multidisciplinary treatment plan to manage their presentation. The authors completed baseline assessment of five main symptom domains and then repeated this assessment following treatment with clozapine. Findings: In all five cases use of clozapine ...
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FAASEN, N; NIEHAUS, D J H; KOEN, L e JORDAAN, E. Undiagnosed metabolic syndrome and other adverse effects among clozapine users of Xhosa descent. S. Afr. j. psyc. [online]. 2014, vol.20, n.2, pp.54-57. ISSN 2078-6786. http://dx.doi.org/10.7196/SAJP.528.. BACKGROUND: Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranu-locytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent. OBJECTIVE: To gather data from Xhosa patients with schizophrenia to establish the prevalence of clozapine side-effects in this population. METHODS: Twenty-nine Xhosa patients with schizophrenia (as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)) who had been receiving clozapine treatment for ,1 year on an outpatient basis were selected for inclusion. All patients were participating in a genetics study in the Cape Metropolitan area. The participants were ...
Aim To compare sole nurse and doctor-led multidisciplinary team delivery of community clozapine services for people with treatment-resistant schizophrenia. Background Around 20% of people with schizophrenia are treatment resistant and fail to respond to front line medications. Clozapine, a second-line treatment, has potentially serious side effects requiring regular monitoring. Different models of community clozapine services are emerging in the British National Health Service, but there is little evidence about which is best. Design Questionnaire survey of service users. Methods All patients on the lists of seven clozapine clinics (four sole nurse, three multidisciplinary team) in one trust were invited to participate, 2009-2010. Forward stepwise regression was used to investigate associations between patient well-being, functioning, self-efficacy and satisfaction, and clinic model attended, controlling for socio-demographic and health characteristics and processes of care. Use (and costs) of ...
Schizophrenia is a mental disorder affecting approximately one percent of the population worldwide. The introduction of the second generation antipsychotic drug, atypical antipsychotic, clozapine, has demonstrated 80% reduction in suicide incident. This drug showed effectiveness in the treatment of resistant schizophrenia, however, high concentrations of clozapine and N-desmethylclozapine in plasma exhibit the development of agranulocytosis, a possible lethal blood disorder. Therefore, constant therapeutic drug monitoring is important for patients who receive clozapine. High performance liquid chromatography (HPLC) is the current assay for clinical clozapine measurement. A different assay, the capillary electrophoresis (CE) was explored in this study. It was found the use of a background electrolyte (BGE) concentration of 60 mM, pH at 2.5, temperature at 22 ℃, voltage applied at 10 kV and sample injection at 23 kV for 1.5 seconds is the optimal condition for clozapine separation using a ...
This multisite study was conducted to compare the efficacy and tolerability of combination treatment with clozapine plus aripiprazole versus combination treatment with clozapine plus haloperidol in patients with schizophrenia who do not have an optimal response to clozapine. Patients continued to take clozapine and were randomly assigned to receive daily augmentation with aripiprazole or haloperidol. Physicians prescribed the allocated treatments according to usual clinical care. Withdrawal from allocated treatment within 3 months was the primary outcome. Secondary outcomes included severity of symptoms on the Brief Psychiatric Rating Scale and antipsychotic subjective tolerability on the Liverpool University Neuroleptic Side Effect Rating Scale. A total of 106 patients with schizophrenia were randomly assigned to treatment. After 3 months, we found no difference in the proportion of patients who discontinued treatment between the aripiprazole and haloperidol groups (13.2% vs 15.1%, P = 0.780). The 3
As part of the new changes, the FDA has clarified and enhanced the prescribing information for clozapine that explains how to monitor patients for neutropenia and manage clozapine treatment. In addition, the agency announced a new, shared risk evaluation and mitigation strategy (REMS) called the Clozapine REMS Program to improve the monitoring and management of patients with severe neutropenia. This program, which will require prescribers, pharmacies, and patients to enroll in a single centralized program, replaces the six existing clozapine registries maintained by individual clozapine manufacturers. ...
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TY - JOUR. T1 - Clozapine attenuates mitochondrial burdens and abnormal behaviors elicited by phencyclidine in mice via inhibition of p47 phox ; Possible involvements of phosphoinositide 3-kinase/Akt signaling AU - Tran, Hai Quyen. AU - Park, Se J.. AU - Shin, Eun Joo. AU - Tran, The Vinh. AU - Sharma, Naveen. AU - Lee, Yu J.. AU - Jeong, Ji H.. AU - Jang, Choon Gon. AU - Kim, Dae Joong. AU - Nabeshima, Toshitaka. AU - Kim, Hyoung Chun. PY - 2018/11/1. Y1 - 2018/11/1. N2 - Background: Oxidative stress and mitochondrial dysfunction have been implicated in the pathophysiology of schizophrenia. Aims: We investigated whether antipsychotic clozapine modulates nicotinamide adenine dinucleotide phosphate oxidase and mitochondrial burdens induced by phencyclidine in mice. Methods: We examined the effect of clozapine on nicotinamide adenine dinucleotide phosphate oxidase activation, mitochondrial burdens (i.e. oxidative stress and mitochondrial dysfunction), and activities of enzymatic antioxidant in the ...
After discontinuing the antipsychotic agents and completing an otherwise negative comprehensive work-up, Clozapine was continued at the same dose CLOZAPINE - ORAL (Clozaril) side effects, medical uses, and Consumer information about the medication CLOZAPINE - ORAL (Clozaril), includes side effects, drug interactions, recommended dosages, and storage information. Read Clozapine and the Mandatory Monitoring System - NEJM Correspondence. Clozapine and the Mandatory Monitoring System. N Engl J Med 1991; 324:490-491 February 14, 1991 DOI: 10.1056/NEJM199102143240712 Prescribing Clozapine - Office of Mental Health Prescribing Clozapine. Although clozapine is not a first line antipsychotic for patients who respond to other antipsychotics, it is one of the most effective Clozapine Withdrawal , Clinical Pharmacy and Pharmacology Stevenson and coauthors describe a case of serotonin syndrome secondary to clozapine withdrawal and together with her failure to improve and negative workup, clozapine (Clozaril, ...
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The noncompetitive NMDA receptor antagonist PCP induces a schizophrenia-like psychosis (including the positive, negative, and cognitive symptoms) in healthy humans and profoundly exacerbates preexisting symptoms in patients with schizophrenia. Thus, the administration of PCP to animals has become an attractive model of schizophrenia (Geyer and Ellenbroek, 2003). Like the atypical antipsychotic drug clozapine, mGlu2/3 receptor agonists have been shown to block PCP hyperactivity in rats (Moghaddam and Adams, 1998; Cartmell et al., 2000a; Monn et al., 2007). In this study, we assessed the ability of LY404039 to block PCP-induced hyperlocomotion in wild-type and mGlu receptor knockout mice. PCP administration increased motor ambulations and distance traveled and decreased the time spent at rest in wild-type and all mGlu receptor-deficient strains, effects that were reversed by the administration of LY404039 (10 mg/kg) in wild-type and mGlu3 receptor-deficient mice. Importantly, the ability of ...
American Journal of Psychiatry, 151:20-26, 1994. Burrell, M.F.; Fewster, C.; Szabadi, E.; and Cashman, M. Clozapine-treated NMS. [Letter] British Journal of Psychiatry, 158:577, 1991. Caine, E.D.; Polinsky, R.J.; Kartzinel, R.; and Ebert, M.H. The trial use of clozapine for abnormal involuntary movement disorders. American Journal of Psychiatry, 136:317-320, 1979. Carroll, B.J.; Curtis, G.C.; and Kokmen, E. Paradoxical response to dopamine agonists in tardive dyskinesia. American Journal of Psychiatry, 134:785-789, 1977. Carson, W.H., and Forbes, R.A. Clozapine-induced weight gain. [Letter] American Journal of Psychiatry, 147:1694, 1990. Casey, D. E. Clozapine: Neuroleptic-induced EPS and tardive dyskinesia. Psychopharmacology, 99(Suppl.):47-53, 1989. Chiles, J.A.; Cohen, S.; and MacNaughton, A. Dropping objects: Possible mild cataplexy associated with clozapine. Journal of Nervous and Mental Disease, 175:663-664, 1990. Chin, E.; Burrows, G.; and Stevenson, J. Double-blind comparison of ...
Clozapine allergy in children - What is the definition or description of: Clozapine allergy? Clozapine Allergy. Clozaril (clozapine) is an antipsychotic medication used for the treatment of schizophrenia. Allergic reactions could include swelling of tongue, throat, lips, mouth, face, hives or difficulty breathing.
This study is investigating the effects of clozapine [CSL Behring] on serum immunoglobulins in patients attending specific clozapine clinics.
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Although antipsychotics currently used in the clinic are generally effective against the positive symptoms of schizophrenia there is still a need to design novel antipsychotics that would be efficacious against the positive and negative symptoms, lack the adverse side effects of current therapy (extrapyramidal motor symptoms, hyperprolactinaemia, agranulocytosis, seizures) and be effective in treatment-resistant patients. Approaches so far in this area have been primarily directed at mimicking the atypical antipsychotic clozapine. The superior clinical profile of clozapine (greater efficacy than typical antipsychotics against positive and possibly negative symptoms of schizophrenia, effective in some refractory patients and causing fewer EPS) has been difficult to pinpoint to a single pharmacological action because clozapine binds with high affinity to many neurotransmitter receptors (Fitton and Heel, 1990; Baldessarini and Frankenburg, 1991). The identification of the dopamine D4 receptor ...
Detailed information on the antipsychotic drug clozapine (also known as Clozaril, Denzapine or Zaponex) including known interactions with other medication, potential side effects and withdrawal effects.
This 12-week, placebo-controlled RCT will be conducted in secondary care, specifically mental health services, at UK centres. The health technology to be assessed is the augmentation of clozapine treatment with another second-generation antipsychotic, amisulpride, which will be compared with placebo: 400mg amisulpride or 1 matching placebo capsule for the first 4 weeks, then the option of titrating up to 800mg amisulpride or 2 matching placebo capsules for the remaining 8 weeks. The study will be double-blind, with medication supplied as identical capsules containing either 400mg amisulpride or placebo. The optimum dose of clozapine at entry and subsequent augmentation will be achieved through a flexible dosing regimen whereby treating psychiatrists will be able to flexibly alter dose regimens to maximise clinical risk-benefit ratios; there will be opportunities for clinical titration of clozapine dose at two and six weeks. Any direct pharmacokinetic effect on clozapine levels will be assessed ...
Fluoxetine increases plasma clozapine concentrations. React. Wkly. 711, 4 (1998). https://doi.org/10.2165/00128415-199807110-00009. Download ...
OBJECTIVE: When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug, it is unclear what other antipsychotic to switch to and when to use clozapine. In this study, the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE) investigation.
Clozapine is an antipsychotic medication. It works by changing the actions of chemicals in the brain. Clozapine is used to treat severe schizophrenia, or to reduce the risk of suicidal behavior in people with schizophrenia or similar disorders. Clozapine is available only from a certified pharmacy under a special...
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Ach release was not the mechanism of clozapine-induced larval arrest.Mutations in genes required for Ach release failed to suppress clozapine-induced developmen
View This PDF. NB: This article is only available as a PDF.. Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.. The publication of the U.S. Clozaril Multicenter Trial more than a decade ago led to the worldwide use of clozapine (Clozaril, Leponex) for treatment-resistant schizophrenia.1 Despite the subsequent introduction of other atypical antipsychotics, clozapine remains the "gold standard" for treatment of this patient population, with superior efficacy compared with conventional antipsychotics. Indeed, it is the only drug with proven efficacy in treatmentresistant schizophrenia.​. J Clin Psychiatry 1999;60(suppl 12):3-3 ...
JL13 [5-(4-methylpiperazin-1-yl)-8-chloro-pyrido[2,3-b][1,5] benzoxazepine fumarate] is a substance with a close structural resemblance to clozapine. However, it is less sensitive to oxidation and may therefore have less hematological side effects. In the present study, JL13 was compared with clozapine and haloperidol in several animal models for schizophrenia. The paw test represents a screening model for antipsychotic drugs that can discriminate between drugs with extrapyramidal side effects and drugs without. Haloperidol increased both forelimb retraction time and hindlimb retraction time (HRT), whereas both clozapine and JL13 increased only HRT. In the prepulse inhibition paradigm, all three drugs reversed the apomorphine- and the amphetamine-induced disruption of prepulse inhibition. However, whereas haloperidol was equally effective against both dopaminergic drugs, JL13 and clozapine were more effective against amphetamine. Finally, only JL13 was able to increase prepulse inhibition in ...
In particular, clozapine has been recommended as treatment for patients with TD who require antipsychotics. Clozapine is one of the most effective atypical neuroleptics for treatment-refractory schizo... more
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In the past weeks, the current health system has been adjusting to prepare for and mitigate the transmission of COVID-19. As a result, Health Canada has asked that health care providers who are prescribing and/or dispensing clozapine review the necessity of their patients conducting blood tests during this time. Health care providers are asked to use their clinical judgement to assess the benefits and risks of continuing treatment in the absence of laboratory testing. They are also asked to share this information with their patients and explain the risks associated with it.. This change in requirement for blood testing will be reassessed in three months or sooner. It is expected that once the COVID-19 related pressures are over, the required blood testing requirements will go back to what they were prior to this situation. BCSS recommends that you talk with the health care provider to find how what this means for you exactly and what you can expect to do during this crisis.. ...
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This trial will compare the efficacy, tolerability and quality-of-life effects of adjunctive sertindole in clozapine-treated patients with schizophrenia. The
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The reality is more complex since the receptor binding profile of clozapine and the newer atypical antipsychotic agents suggests that D2-receptor blockade is not essential for antipsychotic effect. The atypical drugs act on numerous receptors and modulate several interacting transmitter systems. Clozapine is a highly effective antipsychotic. It has little affinity for the D2-receptor compared with classical drugs but binds more avidly to other dopamine subtypes (e.g. D1, D3 and D4). It blocks muscarinic acetylcholine receptors, as do certain classical agents (e.g. ...
Patients with schizophrenia who fail to respond to standard antipsychotic medications have better outcomes if they begin taking the drug clozapine, an atypical
Obtain authorization to dispense each prescription using the Clozapine REMS Program website or by contacting the call center to: verify the prescriber is certified in the REMS Program, verify the patient is enrolled in the REMS Program, verify the ANC is current (within 7 days of the Predispense Authorization transaction for weekly monitoring, 15 days for every two week monitoring and 31 days for monthly monitoring), verify the ANC is within the acceptable range described in the Prescribing Information, or that a certified prescriber has authorized clozapine treatment for patients with an ANC that falls below the acceptable range when the prescriber determines the benefits outweigh the risks of developing severe neutropenia, and report dosing information for each clozapine prescription/fill to the REM Program ...
Clozapine reduces symptoms in patients with schizophrenia who dont benefit from other antipsychotic medications, according to research published online in The American Journal of Psychiatry
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Het Tijdschrift voor Psychiatrie is het toonaangevende wetenschappelijke tijdschrift voor de Nederlandse en Vlaamse psychiaters, arts-assistenten psychiatrie en andere geinteresseerden