Relationship between Clozapine-Induced Electroencephalogram Abnormalities and Serum Concentration of Clozapine in Japanese Patients with Treatment-Resistant Schizophrenia
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
ObjectiveaaThe objective of this study was to investigate the relationship between the serum concentration of clozapine (C-CLZ), Ndesmethylclozapine (N-CLZ) and the daily dose of CLZ (D-CLZ), and the relationships among CLZ and electroencephalogram (EEG) abnormalities. MethodsaaTwenty-eight patients were recruited to this study, but 8 patients were excluded because clozapine was discontinued before the post-treatment measurement of EEG or C-CLZ. Ultimately, 20 patients (6 men, 14 women) with an average age of 36 years were enrolled. The subjects were divided into EEG normal and abnormal groups. C-CLZ and N-CLZ were measured at 4, 12, 26, and 52 weeks after initiating CLZ administration. ResultsaaAll patients had normal baseline EEG signals, and 8 patients showed EEG abnormalities later. There were significant correlations between C-CLZ and D-CLZ, and between N-CLZ and D-CLZ. The C-CLZ/D-CLZ, N-CLZ/D-CLZ, and C-CLZ/N-CLZ ratio were not significantly different between the EEG normal and EEG abnormal groups. The EEG abnormal group had significant higher proportion of patients with high intra-individual variability in their C-CLZ/D-CLZ ratio. ConclusionaaThere is no relationship between C-CLZ and EEG abnormalities. However, patients with high intra-individual variability in their C-CLZ/D-CLZ ratio had greater possibility of exhibiting EEG abnormalities.
Abstract
ObjectiveaaThe objective of this study was to investigate the relationship between the serum concentration of clozapine (C-CLZ), Ndesmethylclozapine (N-CLZ) and the daily dose of CLZ (D-CLZ), and the relationships among CLZ and electroencephalogram (EEG) abnormalities. MethodsaaTwenty-eight patients were recruited to this study, but 8 patients were excluded because clozapine was discontinued before the post-treatment measurement of EEG or C-CLZ. Ultimately, 20 patients (6 men, 14 women) with an average age of 36 years were enrolled. The subjects were divided into EEG normal and abnormal groups. C-CLZ and N-CLZ were measured at 4, 12, 26, and 52 weeks after initiating CLZ administration. ResultsaaAll patients had normal baseline EEG signals, and 8 patients showed EEG abnormalities later. There were significant correlations between C-CLZ and D-CLZ, and between N-CLZ and D-CLZ. The C-CLZ/D-CLZ, N-CLZ/D-CLZ, and C-CLZ/N-CLZ ratio were not significantly different between the EEG normal and EEG abnormal groups. The EEG abnormal group had significant higher proportion of patients with high intra-individual variability in their C-CLZ/D-CLZ ratio. ConclusionaaThere is no relationship between C-CLZ and EEG abnormalities. However, patients with high intra-individual variability in their C-CLZ/D-CLZ ratio had greater possibility of exhibiting EEG abnormalities.
참고문헌 (34)
- Freudenreich O, "Clozapine-induced electroencephalogram changes as a function of clozapine serum levels", Biol Psychiatry, 42, pp.132~137 (1997)
- Günther W, "EEG alterations and seizures during treatment with clozapine. A retrospective study of 283 patients", Pharmacopsychiatry, 26, pp.69~74 (1993)
- Haring C, "Influence of patient-related variables on clozapine plasma levels", Am J Psychiatry, 147, pp.1471~1475 (1990)
- Welch J, "Clozapine-induced seizures and EEG changes", J Neuropsychiatry Clin Neurosci, 6, pp.250~256 (1994)
- Nishant Goyal, "Electroencephalographic Abnormalities in Clozapine-Treated Patients: A Cross-Sectional Study", PSYCHIATRY INVESTIGATION, 8(4), pp.372~376 (2011), 대한신경정신의학회
- Menkes DB, "Steady-state clozapine and norclozapine pharmacokinetics in Maori and European patients", EBioMedicine, 27, pp.134~137 (2018)
- Ng CH, "An inter-ethnic comparison study of clozapine dosage, clinical response and plasma levels", Int Clin Psychopharmacol, 20, pp.163~168 (2005)
- Matsuda KT, "Clozapine dosage, serum levels, efficacy, and side-effect profiles : a comparison of Korean-American and Caucasian patients", Psychopharmacol Bull, 32, pp.253~257 (1996)
- Rajji TK, "Prediction of working memory performance in schizophrenia by plasma ratio of clozapine to N-desmethylclozapine", Am J Psychiatry, 172, pp.579~585 (2015)
- Chang WH, "Clozapine dosages and plasma drug concentrations", J Formos Med Assoc, 96, pp.599~605 (1997)
- 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)
- Piwowarska J, "The usefulness of monitored therapy using Clozapine concentration in the blood serum for determining drug dose in Polish schizophrenic patients", Pharmacol Rep, 68, pp.1120~1125 (2016)
- Haring C, "EEG alterations in patients treated with clozapine in relation to plasma levels", Psychopharmacology(Berl), 114, pp.97~100 (1994)
- Tang Y, "Gender, age, smoking behaviour and plasma clozapine concentrations in 193 Chinese inpatients with schizophrenia", Br J Clin Pharmacol, 64, pp.49~56 (2007)
- Molins C, "Plasma ratio of clozapine to N-desmethylclozapine can predict cognitive performance in treatment-resistant psychotic patients", Psychiatry Res, 258, pp.153~157 (2017)
- Carrillo JA, "Effects of caffeine withdrawal from the diet on the metabolism of clozapine in schizophrenic patients", J Clin Psychopharmacol, 18, pp.311~316 (1998)
- Dettling M, "Long-term therapeutic drug monitoring of clozapine and metabolites in psychiatric in-and outpatients", Psychopharmacology(Berl), 152, pp.80~86 (2000)
- Hägg S, "Effect of caffeine on clozapine pharmacokinetics in healthy volunteers", Br J Clin Pharmacol, 49, pp.59~63 (2000)
- Palego L, "Clozapine, norclozapine plasma levels, their sum and ratio in 50 psychotic patients : influence of patient-related variables", Prog Neuropsychopharmacol Biol Psychiatry, 26, pp.473~480 (2002)
- Perry PJ, "Relationship between patient variables and plasma clozapine concentrations : a dosing nomogram", Biol Psychiatry, 44, pp.733~738 (1998)
- Schaber G, "Pharmacokinetics of clozapine and its metabolites in psychiatric patients : plasma protein binding and renal clearance", Br J Clin Pharmacol, 46, pp.453~459 (1998)
- Seppälä NH, "Clozapine serum concentrations are lower in smoking than in non-smoking schizophrenic patients", Pharmacol Toxicol, 85, pp.244~246 (1999)
- Wetzel H, "Pharmacokinetic interactions of clozapine with selective serotonin reuptake inhibitors : differential effects of fluvoxamine and paroxetine in a prospective study", J Clin Psychopharmacol, 18, pp.2~9 (1998)
- Zullino DF, "Tobacco and cannabis smoking cessation can lead to intoxication with clozapine or olanzapine", Int Clin Psychopharmacol, 17, pp.141~143 (2002)
- Jerling M, "Population pharmacokinetics of clozapine evaluated with the nonparametric maximum likelihood method", Br J Clin Pharmacol, 44, pp.447~453 (1997)
- Diaz FJ, "Estimating the size of the effects of co-medications on plasma clozapine concentrations using a model that controls for clozapine doses and confounding variables", Pharmacopsychiatry, 41, pp.81~91 (2008)
- Haring C, "Dose-related plasma levels of clozapine: influence of smoking behaviour, sex and age", Psychopharmacology (Berl), 99(Suppl), pp.S38~S40 (1989)
- Ulrich S, "Therapeutic drug monitoring of clozapine and relapse--a retrospective study of routine clinical data", Int J Clin Pharmacol Ther, 41, pp.3~13 (2003)
- Centorrino F, "EEG abnormalities during treatment with typical and atypical antipsychotics", Am J Psychiatry, 159, pp.109~115 (2002)
- Naber D, "Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia--a retrospective study of 387 patients", Psychopharmacology (Berl), 99(Suppl), pp.S73~S76 (1989)
- Bondesson U, "Determination of clozapine and its Ndemethylated metabolite in plasma by use of gas chromatography-mass spectrometry with single ion detection", Psychopharmacology(Berl), 95, pp.472~475 (1988)
- 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)
- Anderson SG, "Sex differences in plasma clozapine and norclozapine concentrations in clinical practice and in relation to body mass index and plasma glucose concentrations : a retrospective survey", Ann Gen Psychiatry, 14, pp.39~ (2015)
- Rajkumar AP, "Clinical predictors of serum clozapine levels in patients with treatment-resistant schizophrenia", Int Clin Psychopharmacol, 28, pp.50~56 (2013)