Managing Clozapine Adverse Events
Clozapine was FDA-approved for treatment-refractory schizophrenia in 1989 and has remained the gold standard treatment since then for this indication. Clozapine has established efficacy in both short and long-term treatment for schizophrenia & also improves patients’ functioning and quality of life.
Despite this Clozapine is underutilized due to concerns from an adverse events standpoint. Historically the focus has been on hematologic concerns from clozapine.
On April 5, 2023: JAMA Psychiatry published a viewpoint on the International Variation in Clozapine Hematologic Monitoring. (JAMA Psychiatry. 2023;80(6):535-536)
Here are the proposed suggestions:
- Clozapine-induced agranulocytosis (CIA): occurs primarily in the first 18 weeks of treatment with clozapine.
- There is no evidence suggesting that clozapine causes life-threatening agranulocytosis at a higher incidence than other antipsychotics beyond 1 year.
- The long-term monitoring interval (twice per month or monthly) may be too long to detect a developing CIA.
- Suggestion: Indefinite clozapine monitoring should be abandoned.
- Most Evidence-Based Approach: Restricting hematologic monitoring to the first 12 months of treatment
In the following lecture series by Psychiatry Education Forum Academy, Dr. Harvinder Singh will discuss the hematologic, cardiac, neurological, and gastro-intestinal adverse events with clozapine:
It is important for medical professionals to be aware of the presentation of symptoms, diagnostic findings, and management of each adverse events. This educational activity will educate practitioners about these adverse events so that they feel confident in weighing risks and benefits and consider prescribing clozapine to this treatment-resistant schizophrenia population.
EDUCATIONAL OBJECTIVES:
- To learn the types of clozapine’s adverse events.
- Relationship of these adverse events with clozapine’s dose and duration of treatment.
- Evaluation and Management of clozapine’s adverse events.
- Discuss monitoring protocols with clozapine’s hematologic and cardiac adverse events.
- Learning when to re-challenge vs not re-challenge with clozapine?
LECTURE 1:
HEMATOLOGIC SIDE EFFECTS MANAGEMENT
Here is one of the clinically relevant slides from this discussion:
MANAGEMENT OPTION FOR
ANC: 500-999/uL DURING CLOZAPINE TREATMENT:
LECTURE 2:
CARDIAC SIDE EFFECTS MANAGEMENT
Here is one of the clinically relevant slides from this discussion:
CLOZAPINE DISCONTINUATION & RECHALLENGE WITH MYOCARDITIS
LECTURE 3:
NEUROLOGICAL SIDE EFFECTS MANAGEMENT
Here is one of the clinically relevant slides from this discussion:
CLOZAPINE DOSE & RISK OF SEIZURES
LECTURE 4:
GASTRO-INTESTINAL SIDE EFFECTS MANAGEMENT
Here is one of the clinically relevant slides from this discussion:
CLOZAPINE INDUCED GASTRO-INTESTINAL HYPOMOTILITY: MECHANISM
LECTURE 5:
CLOZAPINE INDUCED HYPERSALIVATION MANAGEMENT
