Back to Search
Start Over
A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology
- Source :
- Psychotherapy and Psychosomatics
- Publication Year :
- 2020
- Publisher :
- S. Karger AG, 2020.
-
Abstract
- Using Richardson and Davidson’s model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
- Subjects :
- medicine.medical_specialty
Myocarditis
Package insert
Clozapine/toxicity
03 medical and health sciences
0302 clinical medicine
Pharmacokinetics
medicine
030212 general & internal medicine
Dosing
Drug reaction
Intensive care medicine
Mortality/drug effects
Applied Psychology
Clozapine
Clozapine/metabolism
Inflammation
Clozapine, blood
business.industry
Drug labeling
COVID-19
General Medicine
medicine.disease
Clozapine/adverse effects
030227 psychiatry
Psychiatry and Mental health
Clinical Psychology
Pneumonia
Schizophrenia
Asian continental ancestry group/genetics
Standard Review Article
Infection
business
medicine.drug
Subjects
Details
- ISSN :
- 14230348 and 00333190
- Volume :
- 89
- Database :
- OpenAIRE
- Journal :
- Psychotherapy and Psychosomatics
- Accession number :
- edsair.doi.dedup.....8f279b8bb5a0d3c913b89d3c7711c3f8