Clozapine

Agranulocytosis related to concurrent clozapine and peg-interferon therapy.

Hepatitis C is a common co-morbidity among the chronically mentally ill. Reported here is a patient with schizophrenia treated with clozapine who developed agranulocytosis after the addition of peg-interferon for hepatits C treatment. Subsequent use of each medication produced further interesting results.

Assessment of Infection Risk during Clozapine Treatment in an Iowa Medicaid Population

Landry and colleagues (2003), reported an increased number of antibiotic prescriptions in the two years following clozapine initiation, compared to the two years prior to clozapine, among a group of chronically hospitalized patients. With the goal of replication in mind, we previously made use of a pre/post-test design to assess infection risk over a 48-month period in outpatients enrolled in the Iowa Medicaid program, and failed to replicate the association between long-term clozapine treatment and risk of infection. However, several methodological limitations were noted.

High Risk - High Alert Medication Management in a State Psychiatric Facility

The Joint Commission on Accreditation of Healthcare Organizations requires that facilities identify high risk- high alert medications to develop specific processes for enhancing patient safety.

Infection risk among patients receiving long-term clozapine treatment.

Clozapine, an atypical antipsychotic, has demonstrated efficacy in the treatment of resistant psychotic illness. Problematic side effects, including agranulocytosis, limit its use as a first line therapy. A full understanding of the hematological complications that may accompany clozapine therapy is yet to be elucidated; however, immunological mechanisms have been implicated. In vitro, clozapine has been shown to alter plasma levels of numerous cytokines and cytokine receptors. Complex networking of cytokines can have activating, proliferative, and differentiating effects on lymphoid cells. While patients who develop significant neutropenia are clearly at high risk for infection, it is unknown whether patients who fail to reach the hematological monitoring thresholds for clozapine discontinuation are also at some increased risk for infection. However, Landry and colleagues (2003) recently reported an increased number of antibiotic prescriptions in the two years following clozapine initiation, compared to the two years prior to clozapine, among a group of chronically hospitalized patients.

Adjunct Divalproex or Lithium to Clozapine in Treatment-Resistant Schizophrenia

While clozapine is effective in treatment-resistant schizophrenia, 50-70% of people have only a partial response. Adjunctive treatment with valproate is frequently used in clinical settings. It is estimated that over one quarter of people in inpatient settings are currently receiving adjunct divalproex.

OVERALL TREATMENT EFFECTIVENESS AS MEASURED BY TIME CONTINUING ON ANTIPSYCHOTIC THERAPY

Antipsychotic discontinuation is associated with diminished treatment effectiveness and increased risk of relapse in schizophrenia, and may occur due to patient or physician decisions encompassing lack of efficacy, adverse events, and other factors. All-cause treatment discontinuation captures all of these reasons and has been identified as an important long-term clinical endpoint.

OVERALL TREATMENT EFFECTIVENESS AS MEASURED BY TIME CONTINUING ON ANTIPSYCHOTIC THERAPY

Antipsychotic discontinuation is associated with diminished treatment effectiveness and increased risk of relapse in schizophrenia, and may occur due to patient or physician decisions encompassing lack of efficacy, adverse events, and other factors. All-cause treatment discontinuation captures all of these reasons and has been identified as an important long-term clinical endpoint.

THE EFFECTS OF SWITCHING ANTIPSYCHOTICS ON LIPIDS: A RETROSPECTIVE CHART REVIEW

Atypical antipsychotic agents have been shown to produce adverse changes in patient lipid panels. These adverse changes occur to the greatest extent with clozapine and olanzapine. Switching antipsychotic therapy from one of these two agents to another atypical antipsychotic could reduce lipid panels, thus potentially reducing the risk of cardiovascular disease. We assessed if switching clozapine or olanzapine to another atypical antipsychotic would produce any changes in patient lipid profiles.

Stability Of Clozapine In Oral Suspension

There is no commercial oral clozapine suspension available. Clozapine suspension prepared using Guy’s Syrup is time consuming and difficult to re-suspend. This product has been given a shelf-life of 14 days. The ability to use a commercially available suspending agent and a longer expiry date will result in a better product ensuring that the patient receives the correct dose and also create significant savings in both preparation time and reduced wasted from outdated product.

Differences Among Antipsychotics in the Time to All-Cause Drug Discontinuation: Results from a Longitudinal Naturalistic Study of Schizophrenia.

Time to treatment discontinuation for any cause was previously identified as an important outcome parameter in the medication management of schizophrenia. This study compared five antipsychotics – clozapine, olanzapine, risperidone, quetiapine, and haloperidol - on the time to all-cause discontinuation, and assessed if these antipsychotics’ time to all-cause discontinuation parallels their reported therapeutic effect size.