An observational study of clozapine induced sedation and its pharmacological management

被引:26
作者
Ramos Perdigues, Sonia [1 ,2 ]
Quecuti, Rosa Sauras [3 ,6 ]
Mane, Anna [1 ,2 ,6 ]
Mann, Louisa [4 ]
Mundell, Clare [4 ]
Fernandez-Egea, Emilio [4 ,5 ,6 ]
机构
[1] Parc Salut Mar, Inst Neuropsiquiatria & Adicc, Barcelona, Spain
[2] Fundacio IMIM, Barcelona, Spain
[3] Ctr Salut Mental Horta, Barcelona, Spain
[4] Cambridgeshire & Peterborough NHS Fdn Trust, Cambridge, England
[5] Univ Cambridge, Dept Psychiat, Behav & Clin Neurosci Inst, Herchel Smith Bldg,Forvie Site Robinson Way, Cambridge CB2 0SZ, England
[6] Ctr Invest Biomed Red Salud Mental CIBERSAM, Barcelona, Spain
关键词
Clozapine; Schizophrenia; Sedation; Drowsiness; Treatment; Management; PLASMA CLOZAPINE; SCHIZOPHRENIA; EFFICACY; CARE; FLUVOXAMINE; RATIO;
D O I
10.1016/j.euroneuro.2015.11.006
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Clozapine induced sedation is common but its management is unclear. We analyzed the factors associated with clozapine-induced sedation and the efficacy of common pharmacological strategies. We conducted a naturalistic observational study using two years electronic records of a cohort patients and three analyses: a cross sectional analysis of factors associated with total number of hours slept (as an objective proxy of sedation), and two prospective analyses of which factors were associated with changes in hours slept and the efficacy of two pharmacological strategies. 133 patients were included, of which 64.7% slept at least 9 h daily. Among monotherapy patients (n=30), only norclozapine levels (r=.367, p=.03) correlated with hours slept. Using the prospective cohort (n=107), 42 patients decreased the number of hours slept, due to decreasing clozapine (40%) or augmenting with aripiprazole (36%). These two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects respectively but the majority (81.8% and 73.9%) did not reduce number of hours slept. Thus, pharmacological and non-pharmacological factors are involved in sedation. Norclozapine plasma levels correlated with total sleeping hours. Reducing clozapine and aripiprazole augmentation were associated to amelioration of sedation, although both strategies were effective only in a limited numbers of subjects. (C) 2015 Elsevier B.V. and ECNP. All rights reserved.
引用
收藏
页码:156 / 161
页数:6
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