본문 바로가기
KERD
논문KCI 등재

Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement

1

조회

0

다운로드

1

인용

0

참고문헌

키워드

초록

Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice. It emphasizes the need to broaden the monitoring beyond the mandatory investigations. This may help in improving the safety in clinical practice and increasing clinician confidence for greater and appropriate use of this effective intervention.

Abstract

Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice. It emphasizes the need to broaden the monitoring beyond the mandatory investigations. This may help in improving the safety in clinical practice and increasing clinician confidence for greater and appropriate use of this effective intervention.

참고문헌 (66)

  1. Schulte P, "What is an adequate trial with clozapine?: therapeutic drug monitoring and time to response in treatmentrefractory schizophrenia", Clin Pharmacokinet, 42, pp.607~618 (2003)
  2. Meltzer HY, "Clozapine: balancing safety with superior antipsychotic efficacy", Clin Schizophr Relat Psychoses, 6, pp.134~144 (2012)
  3. Xiang YT, "Clozapine use in schizophrenia: findings of the Research on Asia Psychotropic Prescription (REAP) studies from 2001 to 2009", Aust N Z J Psychiatry, 45, pp.968~975 (2011)
  4. Tian-Mei Si, "Use of Clozapine for the Treatment of Schizophrenia: Findings of the 2006 Research on the China Psychotropic Prescription Studies", Clinical Psychopharmacology and Neuroscience, 10(2), pp.99~104 (2012), 대한정신약물학회[DOI]
  5. Forrester T, "Increasing clozapine dispensing trends in Queensland, Australia 2004-2013", Pharmacopsychiatry, 48, pp.164~169 (2015)
  6. Mortimer AM, "Clozapine for treatment-resistant schizophrenia: National Institute of Clinical Excellence (NICE) guidance in the real world", Clin Schizophr Relat Psychoses, 4, pp.49~55 (2010)
  7. Nielsen J, "Psychiatrists'attitude towards and knowledge of clozapine treatment", J Psychopharmacol, 24, pp.965~971 (2010)
  8. Cohen D, "Beyond white blood cell monitoring: screening in the initial phase of clozapine therapy", J Clin Psychiatry, 73, pp.1307~1312 (2012)
  9. Taylor DM, "Reasons for discontinuing clozapine: matched, case-control comparison with risperidone long-acting injection", Br J Psychiatry, 194, pp.165~167 (2009)
  10. Nielsen J, "Termination of clozapine treatment due to medical reasons: when is it warranted and how can it be avoided?", J Clin Psychiatry, 74, pp.603~613 (2013)
  11. Alvir JM, "Clozapine-induced agranulocytosis. Incidence and risk factors in the United States", N Engl J Med, 329, pp.162~167 (1993)
  12. Kang BJ, "Long-term patient monitoring for clozapine-induced agranulocytosis and neutropenia in Korea: when is it safe to discontinue CPMS?", Hum Psychopharmacol, 21, pp.387~391 (2006)
  13. Schulte P, "Risk of clozapine-associated agranulocytosis and mandatory white blood cell monitoring", Ann Pharmacother, 40, pp.683~688 (2006)
  14. Patel NC, "Sudden late onset of clozapine-induced agranulocytosis", Ann Pharmacother, 36, pp.1012~1015 (2002)
  15. Lahdelma L, "Clozapine-induced agranulocytosis in Finland, 1982-2007: long-term monitoring of patients is still warranted", J Clin Psychiatry, 73, pp.837~842 (2012)
  16. Aakanksha Singh, "Late Onset Agranulocytosis with Clozapine Associated with HLA DR4 Responding to Treatment with Granulocyte Colony-stimulating Factor: A Case Report and Review of Literature", Clinical Psychopharmacology and Neuroscience, 14(2), pp.212~217 (2016), 대한정신약물학회
  17. Mackin P, "Cardiac side effects of psychiatric drugs", Hum Psychopharmacol, 23(Suppl 1), pp.3~14 (2008)
  18. Merrill DB, "Adverse cardiac effects associated with clozapine", J Clin Psychopharmacol, 25, pp.32~41 (2005)
  19. Hägg S, "Myocarditis related to clozapine treatment", J Clin Psychopharmacol, 21, pp.382~388 (2001)
  20. Ronaldson KJ, "Clinical course and analysis of ten fatal cases of clozapine-induced myocarditis and comparison with 66surviving cases", Schizophr Res, 128, pp.161~165 (2011)
  21. Chung SJ, "Autonomic nervous system related adverse effects developed during clozapine treatment", Korean J Psychopharmacol, 11, pp.168~177 (2000)
  22. Taylor D, "The Maudsley prescribing guidelines in psychiatry" (2012), Wiley-Blackwell
  23. Pramyothin P, "Metabolic syndrome with the atypical antipsychotics", Curr Opin Endocrinol Diabetes Obes, 17, pp.460~466 (2010)
  24. Stroup TS, "Comparative effectiveness of clozapine and standard antipsychotic treatment in adults with schizophrenia", Am J Psychiatry, 173, pp.166~173 (2016)
  25. Mitchell AJ, "Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders--a systematic review and meta-analysis", Schizophr Bull, 39, pp.306~318 (2013)
  26. Ahmed M, "Prevalence and associations of the metabolic syndrome among patients prescribed clozapine", Ir J Med Sci, 177, pp.205~210 (2008)
  27. Softic R, "Metabolic syndrome in schizophrenia - who is more to blame: FGA polypharmacy or clozapine monotherapy?", Psychiatr Danub, 27, pp.378~384 (2015)
  28. Zhang Y, "Metabolic syndrome in patients taking clozapine: prevalence and influence of catechol-O-methyltransferase genotype", Psychopharmacology (Berl), 231, pp.2211~2218 (2014)
  29. Hyde N, "Prevalence of cardiovascular and metabolic events in patients prescribed clozapine: a retrospective observational, clinical cohort study", Curr Drug Saf, 10, pp.125~131 (2015)
  30. Raedler TJ, "Cardiovascular aspects of antipsychotics", Curr Opin Psychiatry, 23, pp.574~581 (2010)
  31. Henderson DC, "Clozapine, diabetes mellitus, hyperlipidemia, and cardiovascular risks and mortality:results of a 10-year naturalistic study", J Clin Psychiatry, 66, pp.1116~1121 (2005)
  32. Koller E, "Clozapineassociated diabetes", Am J Med, 111, pp.716~723 (2001)
  33. "The Electronic Medicines Compendium. Clozaril summary of product characteristics" (2013)[URL]
  34. Nasrallah HA, "Factors in antipsychotic drug selection:tolerability considerations", CNS Spectr, 8(11 Suppl 2), pp.23~25 (2003)
  35. Leonard P, "Prevalence of obesity, lipid and glucose abnormalities in outpatients prescribed clozapine", Ir Med J, 95, pp.119~120 (2002)
  36. Wilson WH, "Clinical review of clozapine treatment in a state hospital", Hosp Community Psychiatry, 43, pp.700~703 (1992)
  37. Freudenreich O, "Clozapine-induced electroencephalogram changes as a function of clozapine serum levels", Biol Psychiatry, 42, pp.132~137 (1997)
  38. Günther W, "EEG alterations and seizures during treatment with clozapine. A retrospective study of 283 patients", Pharmacopsychiatry, 26, pp.69~74 (1993)
  39. Welch J, "Clozapine-induced seizures and EEG changes", J Neuropsychiatry Clin Neurosci, 6, pp.250~256 (1994)
  40. Atkinson JM, "Outcome following clozapine discontinuation: a retrospective analysis", J Clin Psychiatry, 68, pp.1027~1030 (2007)
  41. Funderburg LG, "Seizure following addition of erythromycin to clozapine treatment", Am J Psychiatry, 151, pp.1840~1841 (1994)
  42. Varma S, "Clozapinerelated EEG changes and seizures: dose and plasma-level relationships", Ther Adv Psychopharmacol, 1, pp.47~66 (2011)
  43. Bailey L, "Factors predicting use of laxatives in outpatients stabilized on clozapine", Ther Adv Psychopharmacol, 5, pp.256~262 (2015)
  44. Kusumi I, "Monitoring of side effects induced by psychotropic drugs", Seishin Shinkeigaku Zasshi, 116, pp.116~122 (2014)
  45. Martin J, "British National Formulary (BNF)" (2013), BMJ Group
  46. Meltzer HY, "Effect of clozapine on human serum prolactin levels", Am J Psychiatry, 136, pp.1550~1555 (1979)
  47. Volavka J, "Prolactin levels in schizophrenia and schizoaffective disorder patients treated with clozapine, olanzapine, risperidone, or haloperidol", J Clin Psychiatry, 65, pp.57~61 (2004)
  48. Stark A, "A review of the use of clozapine levels to guide treatment and determine cause of death", Aust N Z J Psychiatry, 46, pp.816~825 (2012)
  49. Flanagan R, "Clozapine therapeutic drug monitoring: why it is important?", British J Clin Pharm, 3, pp.18~20 (2011)
  50. Llorca PM, "Effectiveness of clozapine in neuroleptic-resistant schizophrenia:clinical response and plasma concentrations", J Psychiatry Neurosci, 27, pp.30~37 (2002)
  51. Simpson GM, "Clozapine plasma levels and convulsions", Am J Psychiatry, 135, pp.99~100 (1978)
  52. Cadeddu G, "Clozapine toxicity due to a multiple drug interaction: a case report", J Med Case Rep, 9, pp.77~ (2015)
  53. Taylor D, "Pharmacokinetic interactions involving clozapine", Br J Psychiatry, 171, pp.109~112 (1997)
  54. Spina E, "Effect of fluoxetine on the plasma concentrations of clozapine and its major metabolites in patients with schizophrenia", Int Clin Psychopharmacol, 13, pp.141~145 (1998)
  55. Centorrino F, "Serum levels of clozapine and norclozapine in patients treated with selective serotonin reuptake inhibitors", Am J Psychiatry, 153, pp.820~822 (1996)
  56. Lu ML, "Adjunctive fluvoxamine inhibits clozapine-related weight gain and metabolic disturbances", J Clin Psychiatry, 65, pp.766~771 (2004)
  57. Lu ML, "Fluvoxamine reduces the clozapine dosage needed in refractory schizophrenic patients", J Clin Psychiatry, 61, pp.594~599 (2000)
  58. Légaré N, "Increasing the clozapine: norclozapine ratio with co-administration of fluvoxamine to enhance efficacy and minimize side effects of clozapine therapy", Med Hypotheses, 80, pp.689~691 (2013)
  59. Olesen OV, "Fluvoxamine-clozapine drug interaction:inhibition in vitro of five cytochrome P450 isoforms involved in clozapine metabolism", J Clin Psychopharmacol, 20, pp.35~42 (2000)
  60. Treves IA, "EEG abnormalities in clozapinetreated schizophrenic patients", Eur Neuropsychopharmacol, 6, pp.93~94 (1996)
  61. Haring C, "EEG alterations in patients treated with clozapine in relation to plasma levels", Psychopharmacology (Berl), 114, pp.97~100 (1994)
  62. Malow BA, "Spectrum of EEG abnormalities during clozapine treatment", Electroencephalogr Clin Neurophysiol, 91, pp.205~211 (1994)
  63. Gross A, "Clozapineinduced QEEG changes correlate with clinical response in schizophrenic patients: a prospective, longitudinal study", Pharmacopsychiatry, 37, pp.119~122 (2004)
  64. Khodayari-Rostamabad A, "A pilot study to determine whether machine learning methodologies using pre-treatment electroencephalography can predict the symptomatic response to clozapine therapy", Clin Neurophysiol, 121, pp.1998~2006 (2010)
  65. "Efficacy of somatic treatments in treatment resistant schizophrenia" (2000)[URL]
  66. Singh SP, "Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia:meta-analysis", Br J Psychiatry, 197, pp.174~179 (2010)

관련 논문AI추천

이 간행물의 다른 논문 (15건)