Journal of Clinical Psychopharmacology最新文献

Background: An association between appendicitis and clozapine has been reported, but not studied systematically.

Methods: To document records of clozapine-associated appendicitis/appendectomy, we audited UK MHRA Yellow Card reports classified as clozapine-related gastrointestinal disorders, from 1992 to the end of 2022.

Results: There were 65 unique reports (48 males) where appendicitis/appendectomy were documented and confirmed as occurring while the patient was taking clozapine. There were no significant differences in median age (40/45 y), clozapine dose (362.5/325mg d -1 ), and in the duration of clozapine treatment before the index event (1296/780 d) between men/women, respectively. The reports were coded under 29 different adverse drug reaction terms, most commonly those mentioning abdominal pain (16), constipation (17), ileus paralytic (15), intestinal obstruction (11), and vomiting (13). "Appendix disorder" was only mentioned 4 times. Overall, the coded terms reflected those associated with harmful clozapine-induced gastrointestinal hypomotility (CIGH). The annual number of reports reached 10 in 2011, but have since fallen (no reports: 2022). Appendectomy was recorded 59 times. Peritonitis was mentioned in 10 reports (all 3 deaths), but may have featured in other cases. According to the data, clozapine was continued postoperatively in 27 instances, but stopped in 16.

Conclusions: The data suggest that appendicitis while taking clozapine is often a manifestation of harmful CIGH and can occur at any stage once treatment is established. Every effort must be made to monitor bowel function and ensure that laxative treatment is adhered to when prescribing clozapine.

Background: It is unclear whether treatment with clozapine, when compared directly with other antipsychotics, is differentially associated with metabolic problems among people with treatment-resistant schizophrenia (TRS). We evaluated the prevalence of diabetes, dyslipidemia, obesity, and hypertension, and parameters such as glucose, lipids, weight, and blood pressure of people with TRS managed on clozapine and non-clozapine antipsychotics.

Methods: Demographic, clinical, and metabolic data of patients with TRS who commenced clozapine between 2006 and 2016 at a public hospital were collected in 2023. Participants were divided into those who were on clozapine and those who had discontinued clozapine and were on other antipsychotics when the data were collected. Metabolic disorders of the 2 groups were compared with the t test, the χ 2 test, and the Mann-Whitney U test. The significance level was set at P <0.05.

Results: One hundred six participants with TRS were on treatment with clozapine, and 41 with other antipsychotics. The participants' mean age was 44.3 (SD: 10.2) years, and 74.1% were males. Metabolic disorders such as dyslipidemia (45.6%), obesity (37.4%), and diabetes (22.1%) were prevalent among people with TRS. However, there was no significant difference in diabetes, obesity, and hypertension, and parameters such as blood sugar, lipid levels, and blood pressure between the clozapine and non-clozapine cohorts. While dyslipidaemia was significantly higher among those who were managed on clozapine, 75% of them were prescribed statins.

Conclusions: A comprehensive approach addressing a broad range of risk factors, rather than solely focusing on clozapine, could be beneficial when evaluating and treating metabolic problems among people with TRS.