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클로자핀을 복용중인 조현병 환자의 변비에 영향을 미치는 임상 요인

Clinical Factors Affecting Constipation in Patients with Schizophrenia Taking Clozapine

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주제분류정신과학

초록

Objectives: To investigate clinical factors affecting constipation in patients with schizophrenia taking clozapine. Methods: The participants were patients with schizophrenia taking clozapine and tested for the Therapeutic Drug Monitoring from September 1, 2020 to July 1, 2022 at a university hospital. To evaluate the effect of clozapine on constipation, clozapine dos- age, clozapine concentration, and norclozapine concentration were investigated. To evaluate effects of drugs other than clozapine on constipation, dosage and type of other drug were investigated. Anticholinergic Drug Scale was used to evaluate anticholinergic action. Results: A total of 56 patients were enrolled in the study. Clozapine daily dose, clozapine concentration, and norclozapine con- centration were higher in the constipated patient group. Through logistic regression analysis, it was discovered that the risk of constipation increased as the norclozapine concentration increased, and the results remained similarly even after adjustments of related variables was performed. Conclusion: It was discoverd that among patients taking clozapine, the higher the norclozapine concentration, the higher the probability of constipation. Among patients taking clozapine, patients with high norclozapine concentration may need additional evaluation and management of constipation.

Abstract

Objectives: To investigate clinical factors affecting constipation in patients with schizophrenia taking clozapine. Methods: The participants were patients with schizophrenia taking clozapine and tested for the Therapeutic Drug Monitoring from September 1, 2020 to July 1, 2022 at a university hospital. To evaluate the effect of clozapine on constipation, clozapine dos- age, clozapine concentration, and norclozapine concentration were investigated. To evaluate effects of drugs other than clozapine on constipation, dosage and type of other drug were investigated. Anticholinergic Drug Scale was used to evaluate anticholinergic action. Results: A total of 56 patients were enrolled in the study. Clozapine daily dose, clozapine concentration, and norclozapine con- centration were higher in the constipated patient group. Through logistic regression analysis, it was discovered that the risk of constipation increased as the norclozapine concentration increased, and the results remained similarly even after adjustments of related variables was performed. Conclusion: It was discoverd that among patients taking clozapine, the higher the norclozapine concentration, the higher the probability of constipation. Among patients taking clozapine, patients with high norclozapine concentration may need additional evaluation and management of constipation.

참고문헌 (37)

  1. Siskind D, "first-and second-generation antipsychotics in treatment-refractory schizophrenia : systematic review and meta-analysis", Br J Psychiatry, 209, pp.385~392 (2016)
  2. Young CR, "Management of the adverse effects of clozapine", Schizophr Bull, 24, pp.381~390 (1998)
  3. Alvir JMJ, "Clozapine-induced agranulocytosis--incidence and risk factors in the United States", New England Journal of Medicine, 329, pp.162~167 (1993)
  4. Raja M, "Clozapine safety, 40 years later", Current drug safety, 9, pp.163~195 (2014)
  5. Shirazi A, "Prevalence and Predictors of Clozapine-Associated Constipation : a Systematic Review and Meta-Analysis", Int J Mol Sci, 17, pp.863~ (2016)
  6. Every-Palmer S, "Clozapine-treated patients have marked gastrointestinal hypomotility, the probable basis of life-threatening gastrointestinal complications: a cross sectional study", EBioMedicine, 5, pp.125~134 (2016)
  7. Chengappa KR, "Anticholinergic differences among patients receiving standard clinical doses of olanzapine or clozapine", Journal of Clinical Psychopharmacology, 20, pp.311~316 (2000)
  8. Taylor DM, "Augmentation of clozapine with a second antipsychotic-a meta-analysis", Acta Psychiatr Scand, 125, pp.15~24 (2012)
  9. Nielsen J, "Risk factors for ileus in patients with schizophrenia", Schizophr Bull, 38, pp.592~598 (2012)
  10. Every-Palmer S, "Constipation screening in people taking clozapine : a diagnostic accuracy study", Schizophr Res, 220, pp.179~186 (2020)
  11. West S, "Clozapine induced gastrointestinal hypomotility: a potentially life threatening adverse event. A review of the literature", Gen Hosp Psychiatry, 46, pp.32~37 (2017)
  12. Stubbs B, "Decreased pain sensitivity among people with schizophrenia : a meta-analysis of experimental pain induction studies", Pain, 156, pp.2121~2231 (2015)
  13. Bickerstaff LK, "Pain insensitivity in schizophrenic patients. A surgical dilemma", Arch Surg, 123, pp.49~51 (1988)
  14. De Hert M, "Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level", World Psychiatry, 10, pp.138~151 (2011)
  15. Seidel S, "Antipsychotics for acute and chronic pain in adults", Cochrane Database Syst Rev, pp.CD004844~ (2008)
  16. Olsson E, "Genetic and Clinical Factors Affecting Plasma Clozapine Concentration", Prim Care Companion CNS Disord, pp.17~ (2015)[DOI]
  17. Albitar O, "Population Pharmacokinetics of Clozapine : a Systematic Review", Biomed Res Int, 2020, pp.9872936~ (2020)
  18. Ohlsen R, "Interrater reliability of the Antipsychotic Non-Neurological Side-Effects Rating Scale measured in patients treated with clozapine", Journal of Psychopharmacology, 22, pp.323~329 (2008)
  19. Gardner DM, "International consensus study of antipsychotic dosing", Am J Psychiatry, 167, pp.686~693 (2010)
  20. Bailey L, "Factors predicting use of laxatives in outpatients stabilized on clozapine", Therapeutic Advances in Psychopharmacology, 5, pp.256~262 (2015)
  21. Lu ML, "Adjunctive fluvoxamine inhibits clozapine-related weight gain and metabolic disturbances", J Clin Psychiatry, 65, pp.766~771 (2004)
  22. Szegedi A, "Improved efficacy and fewer side effects under clozapine treatment after addition of fluvoxamine", J Clin Psychopharmacol, 15, pp.141~143 (1995)
  23. Jakobsen M, "The significance of sampling time in therapeutic drug monitoring of clozapine", Acta Psychiatrica Scandinavica, 135, pp.159~169 (2017)
  24. Carnahan RM, "The anticholinergic drug scale as a measure of drug-related anticholinergic burden : associations with serum anticholinergic activity", The Journal of Clinical Pharmacology, 46, pp.1481~1486 (2006)
  25. Eum S, "Cognitive burden of anticholinergic medications in psychotic disorders", Schizophrenia Research, 190, pp.129~135 (2017)
  26. Jun DW, "A population-based study on bowel habits in a Korean community : prevalence of functional constipation and self-reported constipation", Digestive Diseases and Sciences, 51, pp.1471~1477 (2006)
  27. Centorrino F, "Clozapine and metabolites : concentrations in serum and clinical findings during treatment of chronically psychotic patients", J Clin Psychopharmacol, 14, pp.119~125 (1994)
  28. Kuoppamaki M, "Clozapine and N-desmethylclozapine are potent 5-HT1C receptor antagonists", Eur J Pharmacol, 245, pp.179~182 (1993)
  29. Tracy JI, "Relation of serum anticholinergicity to cognitive status in schizophrenia patients taking clozapine or risperidone", Journal of Clinical Psychiatry, 59, pp.184~188 (1998)
  30. Lameh J, "Pharmacology of N-desmethylclozapine", Pharmacol Ther, 115, pp.223~231 (2007)
  31. Weiner DM, "The role of M1 muscarinic receptor agonism of Ndesmethylclozapine in the unique clinical effects of clozapine", Psychopharmacology(Berl), 177, pp.207~216 (2004)
  32. de Leon J, "Serum antimuscarinic activity during clozapine treatment", J Clin Psychopharmacol, 23, pp.336~341 (2003)
  33. Olianas MC, "Agonist activity of N-desmethylclozapine at δ-opioid receptors of human frontal cortex", European Journal of Pharmacology, 607, pp.96~101 (2009)
  34. Chougule A, "Prevalence and factors associated with clozapine-related constipation : an observational study", Journal of Clinical Psychopharmacology, 38, pp.42~46 (2018)
  35. 박선철, "Patterns of Antipsychotic Prescription to Patients with Schizophrenia in Korea: Results from the Health Insurance Review & Assessment Service-National Patient Sample", Journal of Korean Medical Science, 29(5), pp.719~728 (2014), 대한의학회
  36. 김찬우, "정신분열병 및 기타 정신증적 장애로 일 종합병원에 입원한 환자의 치료에서 Clozapine의 사용의 실태 : 유효성 및 부작용", 생물치료정신의학, 9(1), pp.61~68 (2003), 대한생물치료정신의학회
  37. Rostami-Hodjegan A, "Influence of dose, cigarette smoking, age, sex, and metabolic activity on plasma clozapine concentrations: a predictive model and nomograms to aid clozapine dose adjustment and to assess compliance in individual patients", J Clin Psychopharmacol, 24, pp.70~78 (2004)

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