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Clozapine rechallenge following myocarditis: a systematic review of rechallenge cases.
CNS Spectr
December 2024
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Introduction And Objectives: Clozapine is the antipsychotic medication with the greatest efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, clozapine is ceased in approximately 0.2% to 8.
View Article and Find Full Text PDFPsychiatrists' views on clozapine prescribing in Ireland.
Ir J Psychol Med
October 2024
Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland.
Introduction: Despite proven effectiveness in refractory schizophrenia, clozapine remains underutilised, and it is important to understand potential reasons for this. This study's aim was to examine in a National sample of Consultant Psychiatrists their knowledge of, attitudes and perceived barriers to clozapine use.
Methods: A novel questionnaire was designed and distributed by email to 275 Consultant Psychiatrists in Republic of Ireland.
Identifying clinically relevant agranulocytosis in people registered on the UK clozapine Central Non-Rechallenge Database: retrospective cohort study.
Br J Psychiatry
November 2024
Pharmacy Department, Maudsley Hospital, London, UK.
Article Synopsis
- Clozapine is the top antipsychotic for treatment-resistant psychosis, but its use is limited by concerns over agranulocytosis, a potentially dangerous side effect; however, recent evidence suggests not all low blood cell counts indicate this severe reaction.
- The study aimed to analyze the occurrence and timing of clozapine-induced agranulocytosis using various diagnostic criteria, focusing on demographic differences among patients in the UK Central Non-Rechallenge Database.
- Findings showed that 19.6% of patients had threshold-based agranulocytosis, with a higher prevalence in older age groups and among White and male individuals, suggesting a need to reconsider how clinicians assess clozapine's risks and benefits. *
When, Why and How to Re-challenge Clozapine in Schizophrenia Following Myocarditis.
CNS Drugs
September 2024
Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
Article Synopsis
- - Clozapine-induced myocarditis (CIM) is a serious side effect of clozapine treatment for schizophrenia, requiring immediate discontinuation of the drug, which can negatively affect patients' mental health and long-term outcomes.
- - There is growing interest in safely reintroducing clozapine after CIM, with a reported success rate of around 60%, yet research and case reports on this re-challenge process are still limited.
- - The review covers CIM's epidemiology, risks, and management, recommending cautious re-challenge strategies that involve slow dose increases and monitoring key biomarkers to prevent recurrence and ensure patient safety.
Successful Clozapine Rechallenge After Clozapine-Induced Severe Anemia: A Case Report.
Schizophr Bull
April 2024
Department of Psychiatry, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil.
Article Synopsis
- Clozapine is a second-generation antipsychotic recognized as the best treatment for patients with treatment-resistant schizophrenia, though it can cause severe side effects like neutropenia and rare cases of severe anemia associated with pure red cell aplasia (PRCA).
- The case study focuses on a 35-year-old man with treatment-resistant schizophrenia who developed severe anemia from clozapine, but after stopping the drug, his hemoglobin levels recovered.
- Following unsuccessful treatments with other antipsychotics, he was successfully rechallenged with clozapine for 58 days, showing improved psychiatric symptoms and stable hemoglobin, highlighting the importance of careful monitoring during such rechallenges and the need for more research on their outcomes.
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