Clozapine information, risk
Clozapine is a pharmaceutical drug also known as Clozaril. Clozapine is an antipsychotic medication.
Clozapine risk
Myocarditis is a rare but life threatening risk of clozapine. Some symptoms of
myocarditis - elevated temperature, tachycardia and fatigue - appear commonly
during the onset of treatment with clozapine and during the dose titration.
Clozapine not helpful with
risperidone
A double-blind study of combination of clozapine with
risperidone in patients with schizophrenia: effects on cognition.
J Clin Psychiatry. 2006 Dec;67(12):1912-9. Akdede BB, Anil Yagcioglu AE,
Alptekin K, Turgut TI, Tumuklu M, Yazici MK, Jayathilake K, Tunca Z, Gogus A,
Meltzer HY. Department of Psychiatry, Dokuz Eylul University School of Medicine,
Izmir, Turkey.
Atypical antipsychotic drugs produce improvement in some domains of cognition as
well as psychopathology in patients with schizophrenia. However, the effect of
combinations of atypical antipsychotic drugs on cognitive function is unknown.
The aim of this study was to compare the effect of risperidone or placebo on
cognitive function in patients with schizophrenia who were previously treated
with clozapine monotherapy. This prospective, randomized, double-blind,
placebo-controlled, 6-week study included 30 patients with DSM-IV schizophrenia.
Patients whose psychopathology was no more than partially responsive to
clozapine treatment were randomly assigned to receive adjunctive treatment with
risperidone (N = 16) up to 6 mg/day or placebo (N = 14). Cognitive test scores
for verbal learning and memory, verbal fluency, attention, executive function,
verbal working memory, and motor function were the primary outcome measures.
Secondary outcome measures included assessment of psychopathology,
extrapyramidal side effects, and global functioning. Adjunctive treatment with
risperidone for 6 weeks in patients with schizophrenia who had received chronic
treatment with clozapine does not significantly improve
cognitive function.
Clozapine and heart damage
Clozapine-Associated Myocarditis : A Review of 116 Cases of Suspected
Myocarditis Associated with the Use of Clozapine in Australia During 1993-2003.
Drug Saf. 2007;30(1):47-57. Haas SJ, Hill R, Krum H, Liew D, Tonkin A, Demos
L, Stephan K, McNeil J.
Department of Epidemiology & Preventive Medicine, NHMRC Centre of Clinical
Research Excellence in Therapeutics, Faculty of Medicine, Nursing & Health
Sciences, Monash University, Alfred Hospital, Melbourne, Victoria,
AustraliaPharmacy Department, Alfred Hospital, Melbourne, Victoria,
AustraliaDepartment of Epidemiology & Preventive Medicine, Medication Safety
Group, Faculty of Medicine, Nursing & Health Sciences, Monash University, Alfred
Hospital, Melbourne, Victoria, Australia.
Clozapine is an antipsychotic medication associated with a lower suicide rate
compared with other antipsychotic agents. Clozapine is used specifically in
patients for whom previous therapy was inadequate or not tolerated, and is the
only antipsychotic agent associated with the development of myocarditis. To
retrospectively review all adverse drug reaction reports voluntarily submitted
to the Australian Adverse Drug Reactions Unit mentioning suspected myocarditis
in clozapine-treated patients. We accessed all electronic database entries and
case reports citing suspected myocarditis associated with clozapine therapy from
January 1993 through to December 2003, inclusive. Clozapine is
uncommonly but importantly related to myocarditis, often fatal or near fatal and
sometimes in relatively young patients with early onset after treatment
initiation. The most striking feature about this condition is the wide diversity
of nonspecific symptoms that occur in afflicted patients. Additional
pharmacovigilance, improved reporting systems and further investigation of
mechanisms of drug-induced myocarditis and related cardiovascular conditions
(such as heart failure) are clearly warranted. A case-control study would be
suitable for investigation of baseline predictors.
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