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Acta Psychiatr Scand. 2011 Jun;123(6):411-22. doi: 10.1111/j.1600-0447.2011.01710.x. Epub 2011 Apr 28.

Optimizing clozapine treatment.

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  • 1Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Denmark. jin@rn.dk

Abstract

OBJECTIVE:

Clozapine treatment remains the gold standard for treatment-resistant schizophrenia, but treatment with clozapine is associated with several side-effects that complicate the use of the drug. This clinical overview aims to provide psychiatrists with knowledge about how to optimize clozapine treatment. Relevant strategies for reducing side-effects and increasing the likelihood of response are discussed.

METHOD:

Studies of clozapine available in MEDLINE were reviewed.

RESULTS:

A slow up-titration of clozapine is recommended in order to reach the optimal dosage of clozapine and diminish the risk of dose-dependent side-effects. Particularly, in case of partial response or non-response, the use of therapeutic drug monitoring of clozapine is recommended. Plasma levels above the therapeutic threshold of 350-420 ng/ml are necessary to determine non-response to clozapine. To ease the burden of dose-dependent side-effects, dose reduction of clozapine should be tried and combination with another antipsychotic drug may facilitate further dose reduction. For most side-effects, counteracting medication exists. Augmentation with lamotrigine, antipsychotics, or electroconvulsive therapy may be beneficial in case of partial response to clozapine.

CONCLUSION:

Treatment with clozapine should be optimized in order to increase the rate of response and to minimize side-effects, thus diminishing the risk of discontinuation and psychotic relapse.

[PubMed - indexed for MEDLINE]
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