CLOZAPINE

DrugBank ID: db00363
DrugCentral: clozapine
Synonymous :clozapin | clozapina | clozapine | clozapinum


Drug Sentece Context


Table 1. Analysis of context sentence of clozapine gene in 54 abstracts.

pmid sentence
32289791 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.
32376004 Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention.
32420521 Clinicians need to remember that (1) systemic inflammations can increase clozapine level; (2) clozapine, by itself, can cause inflammation, particularly during titration that is too rapid for that patient; (3) clozapine may increase the risk of infection; and (4) more specifically, clozapine may be particularly strongly associated with the risk of pneumonia. […] Pneumonia appears to be associated with high mortality in clozapine patients around the world. […] Clinicians who are alert to the risk of pneumonia in clozapine patients may significantly decrease mortality in clozapine patients. […] There is no data on COVID-19 infections in clozapine patients, but based on what we know about clozapine pharmacology, we can hypothesise that clozapine, possibly by impairing immunological mechanisms, may increase the risk of pneumonia in infected patients. […] More importantly, once fever and/or pneumonia develops, the clozapine dose should be cut in half to decrease the risk of clozapine intoxication. […] If there is any doubt that in spite of halving the dose there are still signs of clozapine intoxication, completely stopping clozapine may be indicated. […] Once the signs of inflammation and fever have disappeared, the clozapine dose can be increased to the prior dosage level.
32542111 Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. […] During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. […] Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc.). […] We recommend decreasing the frequency of physical contacts by extending the blood monitoring interval to 12 weeks in those patients taking clozapine for more than 1 year. […] To distinguish COVID-19 from clozapine-related physical adverse effects, we suggest an urgent antigen test alongside a full blood count. […] In those taking clozapine who develop COVID-19, we suggest continuing with clozapine whenever possible (even during ventilation), reducing the dose if necessary in line with blood assay results. […] Blood monitoring should continue but clozapine should only cease if there is a significant fall in neutrophils (COVID-19 is linked to lymphopenia but not neutropenia). […] To protect against the likelihood and severity of respiratory infection, we recommend the use of vitamin D in all clozapine patients. […] Initiation of clozapine is likely to remain problematic while the risk of infection remains, given the degree of physical contact required to assure safety.
32562033 These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions.
32702224 Clozapine is the most effective antipsychotic for treatment resistant schizophrenia but adverse reactions to clozapine include neutropenia. […] The current COVID-19 pandemic may raise specific concerns for clinicians prescribing clozapine for patients who need it. […] We report on two actively psychotic patients with treatment resistant schizophrenia who required admission to our inner-London acute psychiatric unit during the COVID-19 pandemic and who were treated with clozapine. […] One was a young patient who developed COVID-19 symptoms and tested positive for the SARS-CoV-2 virus while receiving clozapine and the other was an aging man who tested negative for the SARS-CoV-2 virus but had contact with COVID-19 during initiation of clozapine treatment. […] Both responded to clozapine treatment and were safely discharged from hospital without any complication. […] These cases suggest that, in the absence of complications, exposure to COVID-19 per se and the onset of mild symptoms in those infected may not warrant withdrawal or postponement of clozapine treatment when this is indicated.
32713374 Clozapine, an antipsychotic with unique efficacy in treatment-resistant psychosis, is associated with increased susceptibility to infection, including pneumonia. […] To investigate associations between clozapine treatment and increased risk of COVID-19 infection in patients with schizophrenia-spectrum disorders who are receiving antipsychotic medications in a geographically defined population in London, UK. […] People who were on clozapine treatment were compared with those on any other antipsychotic treatment for risk of contracting COVID-19 between 1 March and 18 May 2020. […] We tested associations between clozapine treatment and COVID-19 infection, adjusting for gender, age, ethnicity, body mass index (BMI), smoking status and SLAM service use. […] Individuals who were on clozapine had increased risk of COVID-19 infection compared with those who were on other antipsychotic medication (unadjusted hazard ratio HR = 2.62, 95% CI 1.73-3.96), which was attenuated after adjusting for potential confounders, including clinical contact (adjusted HR = 1.76, 95% CI 1.14-2.72). […] These findings provide support for the hypothesis that clozapine treatment is associated with an increased risk of COVID-19 infection.
32728419 Clozapine is associated with haematological side effects, including neutropaenia, which can signal impending life-threatening agranulocytosis. […] We present 13 patients established on clozapine who developed COVID-19 infection. […] We therefore suggest that patients who develop COVID-19 should generally have their clozapine treatment continued. […] Patients taking clozapine who develop neutroapaenia during COVID-19 infection should be investigated and monitored as in normal practice, because changes in neutrophil counts cannot be assumed to be due to the viral infection.
32890371 Enuresis and MCs’ reactions to clozapine add to the interactive support from (epi-)genetics and imaging.
32974002 There is both uncertainty regarding the safety of clozapine in COVID-19 patients owing to limited published data and a lack of consensus on continuing clozapine in patients with severe respiratory infections. […] COVID-19 is known to induce an acute immune response which can affect haematological parameters associated with clozapine monitoring, and systemic infection may reduce clozapine clearance. […] Clozapine, which has been associated with worse outcomes in some pneumonias, may in theory worsen outcomes in COVID-19. […] Despite these concerns, there are some data to indicate it is safe to continue clozapine in COVID-19 infection. […] In this retrospective case series, we describe our experiences of clozapine prescribing and disease progression of eight SARS-CoV-2 positive patients on medical wards in a major London teaching hospital. […] In four cases clozapine was stopped during the hospital admission. […] Delirium was the most common adverse neuropsychiatric event, and in one case a relapse of psychosis occurred after cessation of clozapine. […] This retrospective case series illustrates the safe use of clozapine during COVID-19 infection. […] Our experiences suggest that consideration should be made to continuing clozapine even in those most unwell with COVID-19.
33012721 We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. […] In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.
33083693 Without additional ECT treatments, the patient again decompensated for several weeks before being stabilised on clozapine, haloperidol and lorazepam.
33110740 This letter concisely outlines our response to the coronavirus pandemic, including the standard operating procedure we introduced and, at a trust level, the changes made to clozapine monitoring.
33187329 clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia (TRS) in adults and is underused. to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 pandemic. a search was performed in two databases (PubMed and Web of Science) using the specific keywords “clozapine” and “schizophrenia”, “side effects”, “agranulocytosis”, “TRS”, or “bipolar affective disorder (BAF)” for the last ten years. clinical trials on adults with acute symptoms of schizophrenia or related disorders. we selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia, (b) CLZ in bipolar disorder, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia, and (f) CLZ therapy and COVID-19 infection. we considered RCTs and CCS from two databases, limited to the search topics. […] Conclusions and implications of key findings: (a) clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions’ severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) a CLZ-associated risk of pulmonary embolism imposes prophylactic measures for venous thromboembolism; (c) convulsive episodes are not an indication for stopping treatment; the plasma concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 infection may enhance clozapine toxicity, generating an increased risk of pneumonia. […] Therapy must be continued with the proper monitoring of the white blood count, and the clozapine dose decreased by half until three days after the fever breaks; psychiatrists and healthcare providers must act together.
33360006 Clozapine is vastly underutilized in the United States and many other countries. […] Despite the notoriety clozapine achieved early in its development, accumulated evidence has demonstrated that close blood monitoring beyond the first year of treatment yields minimal safety benefits. […] Many health care systems have relaxed clozapine blood monitoring requirements during the COVID-19 pandemic for practical reasons, and this presents an opportunity to implement permanent, long overdue changes in mandated monitoring that reflect what has been learned about the real risk for blood dyscrasias with clozapine.
33410987 Remdesivir, baricinitib, and anakinra can be used concomitantly with antipsychotics without risk of drug-drug interaction (except for hematological risk with clozapine and baricinitib).
33527097 Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. […] Adverse reactions to clozapine include neutropenia. […] In March 2020, at the start of the Coronavirus -19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment, and specifically of clozapine, in patients with coronavirus disease. […] We aimed here at providing a short report focusing on the association between neutropenia and clozapine in a case series of psychiatric inpatients diagnosed with COVID-19. […] We retrospectively inspected data of 10 patients on clozapine, admitted to Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, between March and July 2020; selection was based on their COVID-19 positive PCR test. […] Clinicians should bear in mind that a significant drop in neutrophils’ count may occur in patients taking clozapine and affected from a SARS-CoV-2 infectionand that this drop is only transitory.