Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

被引:147
作者
De Berardis, Domenico [1 ]
Rapini, Gabriella [1 ]
Olivieri, Luigi [1 ]
Di Nicola, Domenico [1 ]
Tomasetti, Carmine [2 ,3 ]
Valchera, Alessandro [2 ,4 ]
Fornaro, Michele [3 ]
Di Fabio, Fabio [2 ,5 ]
Perna, Giampaolo [6 ,7 ]
Di Nicola, Marco [8 ]
Serafini, Gianluca [9 ]
Carano, Alessandro [10 ]
Pompili, Maurizio [11 ]
Vellante, Federica [12 ]
Orsolini, Laura [2 ,13 ]
Martinotti, Giovanni [12 ]
Di Giannantonio, Massimo [12 ]
机构
[1] G Mazzini Hosp, Natl Hlth Serv, Dept Mental Hlth Psychiat Serv Diag & Treatment, Pzza Italia 1, I-64100 Teramo, Italy
[2] Polyedra Res Grp, Teramo, Italy
[3] Sch Med Federico II Naples, Dept Neurosci Reprod Sci & Odontostomatol, Naples, Italy
[4] Hermanas Hosp, Villa S Giuseppe Hosp, Ascoli Piceno, Italy
[5] Sapienza Univ Rome, Dept Neurol & Psychiat, Rome, Italy
[6] Maastricht Univ, Italy Dept Psychiat & Neuropsychol, Dept Clin Neurosci,Villa San Benedetto Menni, Hermanas Hosp,FoRiPsi,Albese Con Cassano Como, Maastricht, Netherlands
[7] Univ Miami, Leonard Miller Sch Med, Dept Psychiat & Behav Sci, Miami, FL USA
[8] Univ Cattolica Sacro Cuore, Inst Psychiat & Psychol, Rome, Italy
[9] Univ Genoa, Dept Neurosci Rehabil Ophthalmol Genet Maternal &, Sect Psychiat, Genoa, Italy
[10] Hosp Madonna Soccorso, Dept Mental Hlth Psychiat Serv Diag & Treatment, Natl Hlth Serv, San Benedetto Tronto, Italy
[11] Sapienza Univ Rome, St Andrea Hosp, Dept Neurosci Mental Hlth & Sensory Organs, Suicide Prevent Ctr, Rome, Italy
[12] Univ G DAnnunzio, Dept Neurosci Imaging & Clin Sci, Chair Psychiat, Chieti, Italy
[13] Univ Hertfordshire, Sch Life & Med Sci, Psychopharmacol Drug Misuse & Novel Psychoact Sub, Hatfield, Herts, England
关键词
adverse effects; clozapine; life threatening; management; resistant schizophrenia; NEUROLEPTIC MALIGNANT SYNDROME; INDUCED GASTROINTESTINAL HYPOMOTILITY; COLONY-STIMULATING FACTOR; INDUCED WEIGHT-GAIN; 2ND-GENERATION ANTIPSYCHOTICS; INDUCED MYOCARDITIS; INDUCED AGRANULOCYTOSIS; IN-VITRO; ATYPICAL ANTIPSYCHOTICS; RESISTANT SCHIZOPHRENIA;
D O I
10.1177/2042098618756261
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Clozapine, a dibenzodiazepine developed in 1961, is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. Since its introduction, it has remained the drug of choice in treatment-resistant schizophrenia, despite a wide range of adverse effects, as it is a very effective drug in everyday clinical practice. However, clozapine is not considered as a top-of-the-line treatment because it may often be difficult for some patients to tolerate as some adverse effects can be particularly bothersome (i.e. sedation, weight gain, sialorrhea etc.) and it has some other potentially dangerous and life-threatening side effects (i.e. myocarditis, seizures, agranulocytosis or granulocytopenia, gastrointestinal hypomotility etc.). As poor treatment adherence in patients with resistant schizophrenia may increase the risk of a psychotic relapse, which may further lead to impaired social and cognitive functioning, psychiatric hospitalizations and increased treatment costs, clozapine adverse effects are a common reason for discontinuing this medication. Therefore, every effort should be made to monitor and minimize these adverse effects in order to improve their early detection and management. The aim of this paper is to briefly summarize and provide an update on major clozapine adverse effects, especially focusing on those that are severe and potentially life threatening, even if most of the latter are relatively uncommon.
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收藏
页码:237 / 256
页数:20
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