A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology.

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ID: 104069
2020
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Ranked #15 of 133 articles by views in psychotherapy and psychosomatics

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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.
Reference Key
de-leon2020apsychotherapy Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors de Leon, Jose;Ruan, Can-Jun;Schoretsanitis, Georgios;De Las Cuevas, Carlos;
Journal psychotherapy and psychosomatics
Year 2020
DOI
10.1159/000507638
URL
Keywords
inflammation infection drug labeling covid-19 asian continental ancestry group/genetics clozapine, blood clozapine/adverse effects clozapine/metabolism clozapine/toxicity mortality/drug effects

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