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Title: | The safety and tolerability of clozapine in aged patients: A retrospective clinical file review. | Authors: | Sierakowski C.;Chin L.F.;Singh D.;O'Connor D.W. | Institution: | (O'Connor, Singh) School of Psychology and Psychiatry, Monash University, Melbourne, Australia (Sierakowski) Caulfield Hospital, Melbourne, Australia (Chin) Southern Health, Melbourne, Australia (Singh) Frankston Hospital, Melbourne, Australia | Issue Date: | 12-Oct-2012 | Copyright year: | 2010 | Publisher: | Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom) | Place of publication: | Norway | Publication information: | World Journal of Biological Psychiatry. 11 (6) (pp 788-791), 2010. Date of Publication: September 2010. | Abstract: | Objectives. A clinical file review was conducted of clozapine use in three aged psychiatry services in Melbourne, Australia, to compare its safety and tolerability with findings reported in the literature. Methods. The review period spanned the intervals from 2008 to the services' origins between 11 and 15 years earlier. The files of all patients treated with clozapine during this period were checked with respect to adverse effects and the reasons for ceasing treatment. Results. Clozapine was prescribed to 75 patients (mean age 74.2 years, range 6589) with doses ranging from 25800 mg daily (mean 296 mg). Treatment was stopped within the review period in 37 (49%) cases. Reasons for discontinuation included death (n14), non-fatal adverse events (n=12), patient choice (n=8) and other factors (n=3). While none of the 14 deaths could be linked directly to treatment, orthostatic hypotension might have contributed to a single fatal cerebrovascular accident. There were three cases of "red alert" leukopenia, none of which progressed to agranulocytosis. In general, side effects were more frequent than in a previous report concerning aged patients, most probably because clozapine doses were higher. Conclusions. Most of the adverse events leading to treatment cessation occurred within the first month, emphasising the need for slow titration. Strict monitoring procedures ensured that there were no fatal haematological adverse events. © 2010 Informa UK Ltd. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.3109/15622975.2010.488273 | PubMed URL: | 20586532 [http://www.ncbi.nlm.nih.gov/pubmed/?term=20586532] | ISSN: | 1562-2975 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/30951 | Type: | Review | Subjects: | fever/si [Side Effect] tachycardia/si [Side Effect] *clozapine/ae [Adverse Drug Reaction] *clozapine/dt [Drug Therapy] aged ataxia/si [Side Effect] bipolar disorder/dt [Drug Therapy] cardiomyopathy/si [Side Effect] cerebrovascular disease chronic obstructive lung disease comorbidity diabetes mellitus *drug safety *drug tolerability drug withdrawal dyslipidemia dysphagia/si [Side Effect] electrocardiogram female gastroesophageal reflux heart atrium fibrillation heart infarction/si [Side Effect] heart muscle ischemia human hypertension leukopenia major clinical study male myocarditis/si [Side Effect] orthostatic hypotension/si [Side Effect] Parkinson disease/dt [Drug Therapy] parkinsonism/si [Side Effect] psychopharmacology review schizoaffective psychosis/dt [Drug Therapy] schizophrenia/dt [Drug Therapy] sedation senescence side effect/si [Side Effect] stroke drug withdrawal dyslipidemia dysphagia / side effect electrocardiogram female fever / side effect gastroesophageal reflux heart atrium fibrillation heart infarction / side effect heart muscle ischemia human hypertension leukopenia major clinical study male myocarditis / side effect orthostatic hypotension / side effect Parkinson disease / drug therapy psychopharmacology review schizoaffective psychosis / drug therapy schizophrenia / drug therapy sedation senescence side effect / side effect stroke tachycardia / side effect parkinsonism / side effect cerebrovascular disease cardiomyopathy / side effect bipolar disorder / drug therapy ataxia / side effect aged diabetes mellitus *drug safety *drug tolerability comorbidity chronic obstructive lung disease |
Type of Clinical Study or Trial: | Review article (e.g. literature review, narrative review) |
Appears in Collections: | Articles |
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