scholarly journals Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated withStreptococcus pneumonia, Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female Psychosis

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Christina Voulgari ◽  
Raphael Giannas ◽  
Georgios Paterakis ◽  
Anna Kanellou ◽  
Nikolaos Anagnostopoulos ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Second Generation ◽  
Causal Relation ◽  
Antipsychotic Agent ◽  
Iliac Vein ◽  
Severe Neutropenia ◽  
Caucasian Woman ◽  
Treatment Resistant ◽  
Clozapine Therapy ◽  
Allergic Vasculitis

Clozapine is a second-generation antipsychotic agent from the benzodiazepine group indicated for treatment-resistant schizophrenia and other psychotic conditions. Using clozapine earlier on once a case appears to be refractory limits both social and personal morbidity of chronic psychosis. However treatment with second-generation antipsychotics is often complicated by adverse effects. We present a case of a 33-year-old Caucasian woman with a 25-year history of refractory psychotic mania after switching to a 2-year clozapine therapy. She presented clozapine-induced absolute neutropenia, agranulocytosis, which were complicated byStreptococcus pneumoniaand sepsis. Clozapine-induced thromboembolism of the common femoral and right proximal iliac vein, as well as allergic vasculitis, was diagnosed. She achieved full remission on granulocyte-colony stimulating factor and specific antibiotic treatment. Early detection of severe clozapine-induced absolute neutropenia and agranulocytosis enabled the effective treatment of two among its most severe complications. Additional evidence to the previously reported possible causal relation between clozapine and venous thromboembolism is offered. Finally, clozapine-induced allergic vasculitis is confirmed as a late adverse effect of clozapine therapy.

Clozapine: Serious Adverse Side Effects, Drug Interactions, and Other Complications of Therapy

1996 ◽  
Vol 9 (2) ◽  
pp. 118-129 ◽  
Author(s):  
Deanna M. Guith
Keyword(s):  
Side Effects ◽  
Health Care Professionals ◽  
Elderly Population ◽  
Adverse Reactions ◽  
Psychotic Disorders ◽  
Antipsychotic Agent ◽  
The Elderly ◽  
Pharmacological Properties ◽  
Treatment Resistant ◽  
Clozapine Therapy

Clozapine (Clozaril®, Sandoz, East Hanover, NJ), an atypical antipsychotic agent with pharmacological properties considerably different from standard neuroleptics, has been found to be of great benefit especially to patients with treatment-resistant psychotic disorders. However, it is these unique pharmacological properties that have also been associated with mul tiple side effects ranging from the relatively benign (ie, sialorrhea during sleep, dizziness) to the potentially fatal (ie, agranulocytosis, seizures, and respiratory depression) which have limited its use. These untoward side effects are particularly problematic in the elderly population who often have concomitant medi cal illnesses requiring multiple medication regimens, including psychotropics that may interact with cloza pine (ie, benzodiazepines, cimetidine, fluoxetine). Because even the most benign of side effects has the potential of becoming fatal in certain circumstances if left unaddressed, it is imperative for patients, clinicians, pharmacists, and all health care professionals to be aware of adverse reactions and possible complica tions of clozapine therapy to prevent significant morbidity and mortality. Copyright © 1996 by W.B. Saunders Company

Clozapine underutilization in treatment-resistant schizophrenia

2015 ◽  
Vol 5 (2) ◽  
pp. 63-67
Author(s):  
Robert J. Stanton ◽  
Chris Paxos ◽  
Werner J. Geldenhuys ◽  
B Pharm ◽  
Jessica L. Boss ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Second Generation ◽  
Treatment Resistant ◽  
Antipsychotic Therapy ◽  
Clozapine Therapy ◽  
First Line Therapy ◽  
Therapeutic Benefits ◽  
Second Generation Antipsychotics ◽  
Life Threatening ◽  
Positive And Negative Symptoms

Abstract It has been shown that up to one third of patients with schizophrenia do not respond to antipsychotic therapy. Thus, treatment-resistant schizophrenia (TRS) remains a major mental health care challenge. Clozapine has been shown to provide superior therapeutic benefits and is approved as first-line therapy for TRS. These benefits include improvement in both positive and negative symptoms, and reduction of suicidal behavior in patients with schizophrenia. Clozapine, however, remains significantly underused for TRS. A major reason for clozapine's underuse is its substantial adverse effect profile, mainly the risk of life-threatening agranulocytosis which necessitates regular hematologic monitoring. Another factor contributing to reduced clozapine prescribing is the increased use of other second-generation antipsychotics. In TRS patients, there is often a considerable delay in clozapine use, which is prescribed only after other unsuccessful second-generation antipsychotic trials. To combat this trend, there is a push for increased awareness to optimize clozapine prescribing. An important aspect in improving the use of clozapine therapy is physician and patient education. Furthermore, pharmacist involvement can improve clozapine prescription trends in TRS.

Second-generation antipsychotics: are their similarities greater than their differences?

2003 ◽  
Vol 18 (S2) ◽  
pp. 38s-45s
Author(s):  
W. Wolfgang Fleischhacker
Keyword(s):  
Comparative Studies ◽  
Second Generation ◽  
Rating Scale ◽  
Scientific Evidence ◽  
Treatment Decision ◽  
Antipsychotic Agent ◽  
Generation Agent ◽  
Second Generation Antipsychotics ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

AbstractThe move towards the use of second-generation antipsychotics for the treatment of schizophrenia has provoked much discussion over how to differentiate between the various second-generation agents available on the market. The aim of this review is to provide information that may help clinicians in the decision-making process. The results of comparative studies on general efficacy measures (such as the Positive and Negative Syndrome Scale [PANSS] and the Brief Psychiatric Rating Scale [BPRS]) and comparative studies on cognition do not clearly favour one second-generation agent over another. However, some differences between second-generation agents have become apparent from studies which have examined specific symptoms such as hostility, suicidal ideation and depression/anxiety. There are also differences between second-generation agents with regard to specific aspects of tolerability. For example, in a number of studies olanzapine is associated with fewer extrapyramidal symptoms (EPS) than risperidone, but treatment with risperidone or amisulpride is associated with less weight gain and somnolence. Some studies have investigated the results of switching patients from one antipsychotic agent to another. They have generally reported a successful switch to a second-generation agent.Overall, there is not enough scientific evidence available to clearly favour one second-generation antipsychotic agent over another in terms of general efficacy or tolerability. Therefore, clinicians must make an individualised treatment decision, and select the most appropriate antipsychotic agent for each patient.

scholarly journals Oral Contraceptive Types in Relation to ABO Blood Groups Among Saudi Women of Different Reproductive Age Groups and Impact on Venous Thromboembolism

2020 ◽  
Vol 26 ◽  
pp. 107602962096605
Author(s):  
Abdulrahman B. O. Mohamed ◽  
Nabeel Al-Ama ◽  
Huda Al Kreathy ◽  
Khalid H. B. Ahmed ◽  
Turki Al Amri ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Blood Group ◽  
Protein C ◽  
Second Generation ◽  
Activated Protein C ◽  
Blood Groups ◽  
Fourth Generation ◽  
Third Generation ◽  
Abo Blood Groups ◽  
Saudi Women

Saudi women have recently started using oral contraceptives (OCs), which has led to risk of venous thromboembolism (VTE). The risk varies with the type of OC generations used, and with OC use the risk for VTE increases by 2- to 6-fold. This study evaluated the effect of OC types in relation to ABO blood group on the risk of VTE among Saudi women. Thrombin generation (TG) was measured in the plasma of the women in the presence and absence of platelet rich plasma, platelet poor plasma and thrombomodulin or activated protein C. OC usage increased TG parameters ETP and Peak height by 9.81% and 16.04%, respectively. An increased risk of VTE was seen among women on third generation OCs as compared to those on second generation products. Within OC generations, we found that for women using fourth generation OCs, their ETP increased by 36.18% as compared to those using second generation and by 6.07% in those using third generation compared to those using second generation. There was significant difference with respect to ABO blood groups and OC generation types, but larger sample size is required. Women who are 40 years and older and using third generation OC had a higher risk of having thrombosis (11.84%), as compared to those using second generation OC (8.79%) and to those using fourth generation OC (5.03%). An association between different OC groups and non-O blood group in thrombosis generation was noted. TG parameters were significantly increased in relation to BMI when comparing to OC users versus non-users. In addition, inhibition of TG parameters in the presence of recombinant human thrombomodulin (TM) and activated protein C (APC) were significantly increased.

scholarly journals A Working Hypothesis Regarding Identical Pathomechanisms between Clinical Efficacy and Adverse Reaction of Clozapine via the Activation of Connexin43

2020 ◽  
Vol 21 (19) ◽  
pp. 7019 ◽  
Author(s):  
Motohiro Okada ◽  
Kouji Fukuyama ◽  
Takashi Shiroyama ◽  
Masahiko Murata
Keyword(s):  
Monitoring System ◽  
Clinical Efficacy ◽  
Adverse Reactions ◽  
Clinical Evidence ◽  
Antipsychotic Agent ◽  
World Health ◽  
Treatment Resistant ◽  
Global Database ◽  
The World ◽  
Severe Adverse Reactions

Clozapine (CLZ) is an approved antipsychotic agent for the medication of treatment-resistant schizophrenia but is also well known as one of the most toxic antipsychotics. Recently, the World Health Organization’s (WHO) global database (VigiBase) reported the relative lethality of severe adverse reactions of CLZ. Agranulocytosis is the most famous adverse CLZ reaction but is of lesser lethality compared with the other adverse drug reactions of CLZ. Unexpectedly, VigiBase indicated that the prevalence and relative lethality of pneumonia, cardiotoxicity, and seizures associated with CLZ were more serious than that of agranulocytosis. Therefore, haematological monitoring in CLZ patients monitoring system provided success in the prevention of lethal adverse events from CLZ-induced agranulocytosis. Hereafter, psychiatrists must amend the CLZ patients monitoring system to protect patients with treatment-resistant schizophrenia from severe adverse CLZ reactions, such as pneumonia, cardiotoxicity, and seizures, according to the clinical evidence and pathophysiology. In this review, we discuss the mechanisms of clinical efficacy and the adverse reactions of CLZ based on the accumulating pharmacodynamic findings of CLZ, including tripartite synaptic transmission, and we propose suggestions for amending the monitoring and medication of adverse CLZ reactions associated with pneumonia, cardiotoxicity, and seizures.

Precise pharmacogenetic pharmacometabolomic (PPP) guided clozapine therapy in treatment resistant schizophrenia: Insights from one ethnicity experiment

2021 ◽  
Vol 237 ◽  
pp. 26-28
Author(s):  
Amol N. Patil ◽  
Kripa Shanker Kasudhan ◽  
M. Naveen ◽  
Gurpreet Kaur Batra ◽  
Subho Chakrabarti ◽  
...  
Keyword(s):  
Treatment Resistant ◽  
Clozapine Therapy

scholarly journals Esketamine in Treatment Resistant Depression: The Way to Remission

2021 ◽  
pp. 35-39
Author(s):  
João Facucho-Oliveira ◽  
Daniel Esteves-Sousa ◽  
Bruno Prates ◽  
Rui Neves ◽  
Pedro Varandas
Keyword(s):  
Depressive Symptoms ◽  
Behavioral Therapy ◽  
Symptomatic Relief ◽  
European Medicines Agency ◽  
Caucasian Woman ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Aspartate Receptor ◽  
Resistant Depression

Major depressive disorder affects an estimate of 5% of the population with nearly 1‑third of patients failing to achieve remission with conventional pharmacological treatment. Esketamine, a novel rapid‑acting antidepressant, with a noncompetitive antagonism on N‑methyl‑D‑Aspartate receptor, have been recently approved by Food and Drug Administration (FDA) and European Medicines Agency (EMA) for treatment‑resistant depression. Here, we report a clinical case of a 42‑year‑old Caucasian woman who endured many years with severe depressive symptoms and high functional impairment. Previous treatments included cognitive behavioral therapy, numerous pharmacological trials with antidepressants and augmentation agents, and neurostimulation approaches. Upon treatment with esketamine, the patient presented remarkable clinical recovery. Psychometric assessments determined an acute reduction on the MADRS score after 1 week and progressive recovery of the depressive symptoms on the following weeks. Likewise, PHQ‑9 scale assessments, evaluating the relative frequency of depressive symptoms. and the Sheehan scale, assessing functional recovery, also determined a pronounced symptomatic relief.

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