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22:35 EST 19th November 2019 | BioPortfolio

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Showing "when clozapine" PubMed Articles 1–25 of 63

How to identify and manage non-response to clozapine?

Clozapine is the only approved treatment for Treatment-Refractory Schizophrenia. Here we describe a case series of three hospitalized patients with clozapine nonresponse. One of them responded to clozapine after dose adjustments were made for an interaction between clozapine and ciprofloxacin. The other two cases remained clozapine nonresponders despite optimizing clozapine treatment. However, both these patients responded to other antipsychotic medications (APMs) with better tolerability than observed with...


Obstetric and neonatal outcomes of clozapine exposure in pregnancy: a consecutive case series.

Clozapine is an effective antipsychotic that can lead to symptom resolution and functional recovery in patients with schizophrenia. Its available pregnancy safety data remain limited, which presents a challenge for clinicians managing women of reproductive age on clozapine. We retrospectively studied a consecutive case series of nine pregnancies where there was clozapine exposure. Our case series demonstrates that pregnant women on clozapine treatment can remain stable psychiatrically, but are vulnerable ob...

Increased Clozapine Levels During Infection: more Frequent than Assumed?

Systemic infections are known to alter the metabolism of various drugs via inhibition of the cytochrome P450 family. Here, we report the cases of two patients with schizophrenic psychosis and highly elevated clozapine levels during pulmonary systemic infection, however without experiencing side effects. After antibiotic treatment and temporary reduction of clozapine dosage blood levels of clozapine normalized within a few days. These cases show that clozapine levels may be highly elevated without necessaril...


Addressing clozapine under-prescribing and barriers to initiation: a psychiatrist, advanced practice provider, and trainee survey.

Clozapine use has declined, despite its superior antipsychotic efficacy in treatment-resistant schizophrenia. Implications for clozapine underutilization include suboptimal treatment outcomes and increased hospitalizations. Many barriers preventing the use of clozapine have been described in the literature, including suboptimal knowledge and poor perceptions. The aim of this study was to assess psychiatry prescribers' perception and knowledge of clozapine. A survey was distributed to advanced practice provi...

Clozapine administration enhanced functional recovery after cuprizone demyelination.

The atypical antipsychotic agent, clozapine, is used to treat a variety of neurological disorders including schizophrenia and Parkinson's disease and readily crosses the blood brain barrier to interact with a wide range of neuroreceptors including those for dopamine and serotonin. Recent work has shown that clozapine can reduce neuroinflammation in experimental autoimmune encephalomyelitis, a neuroinflammatory model of multiple sclerosis (MS) and mediates its effects in the central nervous system. To furthe...

Delayed complications after severe clozapine intoxication: a case report. The pharmacokinetic profile of clozapine and it's important role in the course of symptoms.

Clozapine intoxications have a varied clinical presentation and may have severe complications. Management and treatment guidelines rarely highlight the risks of delayed clinical presentations. We present the case of a 50-year-old man showing severe complications 15 hours after intoxication with 4200 mg clozapine. Treatment consisted of strict monitoring, including vital support and regular clozapine blood levels. Clinical presentations may be delayed up to 5 days after intoxication, for which strict monitor...

Clozapine Disrupts Endothelial Nitric Oxide Signaling and Antioxidant System for its Cardiovascular Complications.

Many drugs in current practice require additional safety labels in order to prevent potential risks to the major organ system. Psychotropic agent clozapine has been reported to produce myocarditis and other cardiac complications on repeated use. Our study aimed to establish the role of clozapine in vascular damage associated with nitric oxide metabolism.

How and when to use clozapine.

Clozapine is the only approved strategy for treatment resistant schizophrenia, although it is highly under-utilized. We aim to generate practical and actionable evidence-based recommendations for the use of this drug considering prescription barriers.

Estimating the Risk of Pneumonia in Patients With Schizophrenia Newly Receiving Clozapine: A Nationwide Cohort Study.

Patients with schizophrenia are vulnerable to pneumonia. Clozapine is associated with the greatest risk of pneumonia. We investigated the risk factors of pneumonia in patients with schizophrenia who use clozapine.

Clozaril Withdrawal Induced Catatonia

Aim To describe an uncommon side effect of sudden withdrawal of Clozapine. Method This case describes the occurrence of catatonia following the sudden discontinuation of long term Clozapine therapy. Results Symptoms resolved with treatment with benzodiazepines and IV fluids. Discussion In conclusion, catatonia can occur on sudden discontinuation of Clozapine therapy. Caution should be exercised when reducing or discontinuing this medication.

Association With Hospitalization and All-Cause Discontinuation Among Patients With Schizophrenia on Clozapine vs Other Oral Second-Generation Antipsychotics: A Systematic Review and Meta-analysis of Cohort Studies.

Recent meta-analyses of randomized clinical trials (RCTs) comparing clozapine with nonclozapine second-generation antipsychotics (NC-SGAs) in schizophrenia have challenged clozapine's superiority in treatment-resistant patients. However, patients in RCTs are not necessarily generalizable to those in clinical practice.

Abnormal Behavior of Zebrafish Mutant in Dopamine Transporter Is Rescued by Clozapine.

Dopamine transporter (SLC6A3) deficiency causes infantile Parkinson disease, for which there is no effective therapy. We have explored the effects of genetically deleting SLC6A3 in zebrafish. Unlike the wild-type, slc6a3-/- fish hover near the tank bottom, with a repetitive digging-like behavior. slc6a3-/- fish manifest pruning and cellular loss of particular tyrosine hydroxylase-immunoreactive neurons in the midbrain. Clozapine, an effective therapeutic for treatment-resistant schizophrenia, rescues the ab...

Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats.

Many studies have been reported the efficacy of intravenous lipid emulsion (ILE) as an antidote on acute lipophilic drug toxicity. Clozapine, highly lipophilic dibenzodiazepine neuroleptics, is an important medication in the schizophrenia therapy regimen. Acute intoxication with antipsychotics is one of the main reasons for the referral of poisoned patients to the hospital. We expected that ILE could be used for the therapy of acute clozapine intoxicated patients.

Functioning and cognitive characteristics of clozapine users referred to psychosocial rehabilitation centers: A REHABase cohort study.

To explore whether clozapine users have specific rehabilitation needs compared to users of other antipsychotics.

The Effects of Co-prescription of Pantoprazole on the Clozapine Metabolism.

Polypharmacy including somatic medications such as proton pump inhibitors is a common phenomenon in psychiatric care. The aim of this study was to evaluate the pantoprazole effects on clozapine metabolism.

A comparative study of detection of myocarditis induced by clozapine: With and without cardiac monitoring.

The aim of this study was to investigate and compare the incidence of suspected or definite cases of clozapine induced myocarditis (SDM) and clinical factors which could influence its onset in two different time periods, defined by pre- and post-cardiac monitoring at an inpatient setting, during the initiation phase of clozapine treatment. Hospital records of patients started on clozapine in the inpatient unit between 2011 and 2018 were investigated. Eight in 38 patients (11.3%) were classified as SDM after...

Clozapine and cardiotoxicity - A guide for psychiatrists written by cardiologists.

This review discusses the rare but potentially life-threatening cardiovascular side-effects of myocarditis and dilated cardiomyopathy associated with the use of Clozapine. The clinical presentation of these conditions is non-specific, making it difficult to both risk-stratify and identify patients who develop these consequences. This review aims to examine the proposed aetiologies, diagnostic approaches and subsequent management strategies of cardiotoxicity associated with clozapine use; offering guidance t...

Real-World Outcomes in the Management of Refractory Psychosis.

Clozapine is the only medication approved for those patients with schizophrenia who do not achieve a clinical response to standard antipsychotic treatment, yet it is still underused. Furthermore, in the case of a partial or minimal response to clozapine treatment, there is no clarity on the next pharmacologic intervention.

In vivo study to compare the effects of Choline with Fluoxetine and Clozapine for the modulation of cognitive behavior (Learning Memory and Exploratory Behavior).

Cognitive behavior is associated with physiological processes that affect the working performance of an individual. Cognitive control is used to override self-serving impulses and behave in socially desirable manner. The objective of the study is to compare the effects of Choline with Fluoxetine and Clozapine for the modulation of cognitive behavior including learning, memory, locomotor, exploratory behavior and anxiety. The study was based on twenty four albino rats divided into four equal groups: (1) Cont...

A systematic review of sex-based differences in effectiveness and adverse effects of clozapine.

Clozapine is one of the most widely used antipsychotics for treating psychiatric illnesses such as schizophrenia and bipolar disorder. This drug, however, is associated with adverse effects such as weight gain, metabolic syndrome, and blood dyscrasias. The manifestations of mental illness may differ between men and women. Yet, there is little evidence on the influence of sex on treatment response or the occurrence of AEs. To fill this gap of knowledge, we carried out a systematic review of the literature on...

Novel Treatment for the hardest-to-treat Schizophrenia: Dual Activation of NMDA Receptor and Antioxidant.

Clozapine has been regarded as the last-line antipsychotic agent for patients with refractory schizophrenia. However, many patients remain unresponsive to clozapine, referred to as "clozapine-resistant", "ultra-treatment-resistant", or "hardest-to-treat". There has been no convincing evidence for augmentation on clozapine so far. Novel treatments including numerous N-methyl-D-aspartate (NMDA) receptor (NMDAR) enhancers such as glycine, D-serine, D-cycloserine, and N-methylglycine (sarcosine) failed in clini...

Structure-Kinetic Profiling of Haloperidol Analogues at the Human Dopamine D Receptor.

Haloperidol is a typical antipsychotic drug (APD) associated with an increased risk of extrapyramidal side-effects (EPS) and hyperprolactinemia relative to atypical APDs such as clozapine. Both drugs are dopamine D receptor (DR) antagonists, with contrasting kinetic profiles. Haloperidol displays fast association/slow dissociation at the DR whereas clozapine exhibits relatively slow association/fast dissociation. Recently, we have provided evidence that slow dissociation from the DR predicts hyperprolactine...

Differential effects of antipsychotic drugs on contrast response functions of retinal ganglion cells in wild-type Sprague-Dawley rats and P23H retinitis pigmentosa rats.

Antipsychotic drugs haloperidol and clozapine have been reported to increase the sensitivity of retinal ganglion cells (RGCs) to flashes of light in the P23H rat model of retinitis pigmentosa. In order to better understand the effects of these antipsychotic drugs on the visual responses of P23H rat RGCs, I examined the responses of RGCs to a drifting sinusoidal grating of various contrasts. In-vitro multielectrode array recordings were made from P23H rat RGCs and healthy Sprague-Dawley (SD) rat RGCs. Retina...

Use of Valproate and Clozapine During Course of Chemoradiation in a Patient with Malignancy.

Clozapine and Evidence-Based Psychopharmacology for Schizophrenia.


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