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Introduction: Clozapine is an atypical antipsychotic drug approved for treatment-resistant schizophrenia (TRS). Despite its high efficacy for TRS, clozapine is associated with several serious adverse effects, such as neutropenia and diabetes, so it requires vigilant monitoring. Severe anemia has also been documented as a rare but serious complication with an unclear mechanism.

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High Burden of Ileus and Pneumonia in Clozapine-Treated Individuals With Schizophrenia: A Finnish 25-Year Follow-Up Register Study.

Am J Psychiatry

October 2024

Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie).

Objective: The authors used longitudinal biobank data with up to 25 years of follow-up on over 2,600 clozapine users to derive reliable estimates of the real-world burden of clozapine adverse drug events (ADEs).

Methods: A total of 2,659 participants in the FinnGen biobank project had a schizophrenia diagnosis and clozapine purchases with longitudinal electronic health record follow-up for up to 25 years after clozapine initiation. Diseases and health-related events enriched during clozapine use were identified, adjusting for disease severity.

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Article Synopsis
  • Clozapine, a medication for schizophrenia, can cause diabetes, but there is little research on its effects on glucose levels in patients.
  • A case is reported where a patient experienced repeated reactive hypoglycemia linked to abnormal glucose tolerance while on clozapine.
  • Regular monitoring of glucose levels is crucial during clozapine treatment to prevent complications and potential discontinuation of the medication.
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