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Lessons learnt in the end-of-life management of a hospice inpatient with advanced oropharyngeal cancer established on clozapine for treatment-resistant schizophrenia.
BMJ Case Rep
December 2024
Palliative Medicine, Aneurin Bevan University Health Board, Newport, UK.
Article Synopsis
- Clozapine is a critical medication for treatment-resistant schizophrenia but must be used carefully due to its narrow therapeutic range and potential for serious side effects.
- Patients with mental health issues often have heightened risks for head and neck cancers from lifestyle factors and may struggle to access adequate healthcare.
- Effective management requires careful planning, ongoing monitoring, and collaboration among healthcare professionals to balance the risks of clozapine toxicity and underdosing in patients with declining health.
Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data.
Eur Child Adolesc Psychiatry
December 2024
Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA.
Article Synopsis
- Clozapine use is primarily associated with the risk of neutropenia, but there is limited research on adverse drug reactions (ADRs) and fatal outcomes in patients under 18 years old.
- A study analyzed 2,825 reports of clozapine usage in this age group, revealing 42 fatal outcomes, with the most common ADR being decreased white blood cell count, while suicide was a significant cause of non-duplicated fatalities.
- To better prevent fatal outcomes in young patients, child and adolescent psychiatrists should broaden their focus beyond severe neutropenia to include other serious ADRs like pneumonia, while still being cautious of the risk of overdose in those at risk for suicide.
Pharmacovigilance in Action: Utilizing VigiBase Data to Improve Clozapine Safety.
Patient Prefer Adherence
November 2024
Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA.
Purpose: Clozapine is an antipsychotic which was approved in 1989 for treatment-resistant schizophrenia in the United States (US). There were few randomized trials before its approval and potentially lethal clozapine adverse drug reactions (ADRs), such as agranulocytosis and myocarditis were identified by pharmacovigilance. VigiBase, the WHO global database, is a cornerstone of international pharmacovigilance efforts for ADR identification during post-marketing surveillance.
View Article and Find Full Text PDFClozapine Toxicity Predictor: Deep neural network model predicting clozapine toxicity and its therapeutic dose range.
Psychiatry Res
December 2024
Medical University of Lodz, Department of Old Age Psychiatry and Psychotic Disorders, Czechosłowacka 8/10, 92-216 Łódź, Poland.
Article Synopsis
- * The study introduces a new deep neural network that predicts clozapine and norclozapine concentrations, toxicity, and therapeutic dose ranges using data from patients treated with clozapine.
- * This predictive model is freely available as a web application for clinicians, allowing improved management of clozapine dosing despite limited access to traditional therapeutic drug monitoring.
A Simple HPLC-DAD Method for the Therapeutic Monitoring of Clozapine and Related Metabolites in Human Plasma and Urine Samples.
Molecules
October 2024
Department of Analytical & Physical Chemistry, Faculty of Chemistry, University of Bucharest, Panduri Ave. # 90-92, 050663 Bucharest, Romania.
Clozapine and its metabolites require close therapeutic monitoring (TDM) in patients due to poor correlation between the administrated doses and resulting plasma concentrations, the narrow therapeutic interval, high inter-individual variability, and the risk of serious side effects once toxic levels are exceeded. The aim of the study was to develop a simple (relatively cheap) LC-UV method for the quantification of clozapine and its metabolites in plasma and urine samples. For sample preparation, liquid-liquid extraction (LLE) in -octanol was more efficient and less limiting in injection volumes compared to the in-situ formation of SUPRAS.
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