Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-23T08:19:18.926Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Management of Clozapine Patients in Relation to Efficacy and Side-Effects

Published online by Cambridge University Press:  06 August 2018

D. Naber ,
R. Holzbach ,
C. Perro  and
H. Hippius
D. Naber
Affiliation:
Psychiatric Hospital, University of Munich, Nussbaumstraße 7, D-8000 Munich 2, Germany
R. Holzbach
Affiliation:
Psychiatric Hospital, University of Munich, Nussbaumstraße 7, D-8000 Munich 2, Germany
C. Perro
Affiliation:
Psychiatric Hospital, University of Munich, Nussbaumstraße 7, D-8000 Munich 2, Germany
H. Hippius
Affiliation:
Psychiatric Hospital, University of Munich, Nussbaumstraße 7, D-8000 Munich 2, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

Medical charts of 480 schizophrenic in-patients (581 treatments) were analysed to evaluate the efficacy and side-effects of clozapine. Clozapine treatment lasted for mean 49 (s.d. 38) days. Of the sample, 11.0% showed worsening or no change, 31.5% slight improvement, 53.0% marked improvement and 4.5% almost total reduction of symptoms. At least one major side-effect occurred in 68.0% of patients. A combination of clozapine with classical neuroleptics, antidepressants, benzodiazepines or lithium is tolerated by most patients, but increases the incidence of some side-effects. Clozapine treatment had to be discontinued because of severe side-effects in 8.6% of patients. In 81 schizophrenic out-patients, clozapine significantly reduced the days of in-patient treatment and number of hospital readmissions. Two patients developed leucopenia but had no complications after clozapine withdrawal. This study indicates a satisfactory benefit/risk ratio and compliance in most of the patients.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 160 , Issue S17: Clozapine - The Atypical Antipsychotic , May 1992 , pp. 54 - 59
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baker, R. W. & Conley, R. R. (1991) Seizures during clozapine therapy. American Journal of Psychiatry, 148, 1265–1266.Google Scholar
Baldessarini, R. J. & Frankenburg, F. R. (1991) Clozapine. A novel antipsychotic agent. New England Journal of Medicine, 324, 746–754.Google ScholarPubMed
Bauer, D. & Gaertner, H. J. (1983) Wirkungen der Neuroleptika auf die Leberfunktion, das blutbildende System, den Blutdruck und die Temperaturregulation. Pharmakopsychiatrie, 16, 23–29.CrossRefGoogle Scholar
Blum, A. & Mauruschat, W. (1972) Temperaturanstiege und Bluteiweißveränderungen unter der Therapie mit Neuroleptika -unter besonderer berücksichtigung des neurartigen Dibenzo-diazepin-Derivates Clozapin. Pharmakopsychiatrie, 5, 155–169.CrossRefGoogle Scholar
Claghorn, J., Honigfeld, G., Abuzzahab, F. S., et al (1987) The risk and benefits of clozapine versus chlorpromazine. Journal of Clinical Psychopharmacology, 7, 377–384.Google Scholar
Cohen, B. M., Keck, P. E., Satlin, A., et al (1991) Prevalence and severity of akathisia in patients on clozapine. Biological Psychiatry, 29, 1215–1219.CrossRefGoogle ScholarPubMed
Devinsky, O., Honigfeld, G. & Patin, J. (1991) Clozapine-related seizures. Neurology, 41, 369–371.CrossRefGoogle ScholarPubMed
Fink, M., Irwin, P. & Weinhold, P. (1979) EEG profile studies of clozapine in volunteers and psychiatric patients. Pharmakopsychiatrie, 12, 184–190.Google Scholar
Fitton, A. & Heel, R. C. (1990) Clozapine. A review of its pharmacological properties, and therapeutic use in schizophrenia. Drugs, 40, 722–747.CrossRefGoogle ScholarPubMed
Gerlach, J., Jorgensen, E. O. & Peacock, L. (1989) Long-term experience with clozapine in Denmark: research and clinical practice. Psychopharmacology, 99 (suppl.), S92–S96.CrossRefGoogle ScholarPubMed
Gouzoulis, E., Grunze, H. & von Bardeleben, U. (1991) Myoclonic epileptic seizures during clozapine treatment: a report of three cases. European Archives of Psychiatry and Clinical Neurosciences, 240, 370–372.Google Scholar
Grohmann, R., Rüther, E. & Sassim, N. (1989a) Adverse effects of clozapine. Psychopharmacology, 99 (suppl.), S101–S104.Google Scholar
Grohmann, R., Schmidt, L. G., Spie$sZ-Kiefer, C., et al (1989b) Agranulocytosis and significant leucopenia with neuroleptic drugs: Results from the AMÜP program. Psychopharmacology, 99 (suppl.), S109–S112.CrossRefGoogle ScholarPubMed
Haller, E. & Binder, R. L. (1990) Clozapine and seizures. American Journal of Psychiatry, 147, 1069–1071.Google ScholarPubMed
Hippius, H. (1989) History of clozapine. Psychopharmacology, 99 (suppl.), S3–S5.Google Scholar
Isermann, H. & Haupt, R. (1976) Auffällige EEG-Veränderungen unter Clozapin-Behandlung bei paranoid-halluzinatorischen Psychosen. Nervenarzt, 47, 268.Google Scholar
Kane, J., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.Google Scholar
Kirkegaard, A., Hammershoj, E. & Ostergard, P. (1982) Evaluation of side effects due to clozapine in long-term treatment of psychosis. Arzneimittel-Forschung/Drug Research, 32, 465–468.Google Scholar
Koukkou, M., Angst, J. & Zimmer, D. (1979) Paroxysmal EEG activity and psychopathology during the treatment with clozapine. Pharmakopsychiatrie, 12, 173–183.Google Scholar
Krupp, P. & Barnes, P. (1989) Leponex-associated granulocytopenia: a review of the situation. Psychopharmacology, 99 (suppl.), S118–S121.Google Scholar
Kuha, S. & Miettinen, E. (1986) Long-term effect of clozapine in schizophrenia. A retrospective study of 108 chronic schizophrenics treated with clozapine for up to 7 years. Nordiske Psykiatriske Tidsskrift, 40, 225–230.Google Scholar
Lindström, L. H. (1988) The effect of long-term treatment with clozapine in schizophrenia: a retrospective study in 96 patients treated with clozapine for up to 13 years. Acta Psychiatrica Scandinavica, 77, 524–529.CrossRefGoogle ScholarPubMed
Meltzer, H. Y. (1991) The mechanism of action of novel antipsychotic drugs. Schizophrenia Bulletin, 17, 263–287.Google Scholar
Naber, D., Leppig, M., Grohmann, R., et al (1989) Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia - a retrospective study of 387 patients. Psychopharmacology, 99 (suppl.), S73–S76.Google Scholar
Naber, d. & Hippius, H. (1990) The European experience with use of clozapine. Hospital and Community Psychiatry, 41, 886–890.Google Scholar
Naber, d., Hackl, C., Marcelli, B., et al (1992) Zur subjektiven Wirkung von Clozapin in Vergleich zo typischen Neuroleptika. In Clozapin. Pharmakologie und Klinik eines atypischen Neuroleptikums. Eine Kritische Bestandsaufnahme (eds d. Naber & F. Müller-Spahn), in press. Stuttgart: Schattauer.Google Scholar
Perry, P. J., Miller, d. d., Arndt, S. V., et al (1991) Clozapine and norclozapine plasma concentrations and clinical response of treatment-refractory schizophrenic patients. American Journal of Psychiatry, 148, 231–235.Google Scholar
Povlsen, U. J., Noring, U., Fog, R., et al (1985) Tolerability and therapeutic effect of clozapine. A retrospective investigation of 216 patients treated with clozapine for up to 12 years. Acta Psychiatrica Scandinavica, 71, 176–185.CrossRefGoogle Scholar
Safferman, A., Lieberman, J. A., Kane, J. M., et al (1991) Update on the clinical efficacy and side effects of clozapine. Schizophrenia Bulletin, 17, 247–261.Google Scholar
Sassim, N. & Grohmann, R. (1988) Adverse drug reactions with clozapine and simultaneous application of benzodiazepines. Pharmakopsychiatrie, 21, 306–307.Google Scholar
Spatz, R., Lorenzi, E., Kugler, J., et al (1978) Häufigkeit und Form von EEG-Anomalien bei Clozapintherapie. Arzneimittel-Forschung/Drug Research, 28, 1499–1500.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.