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Clozapine Titration for People in Early Psychosis: A Chart Review and Treatment Guideline.

Abstract：

PURPOSE/BACKGROUND:The use of clozapine, particularly in young people, is often limited by early treatment-emergent adverse effects including drowsiness and lethargy. Concerns about adverse effects, medication adherence, and the need for blood monitoring often impede the use of clozapine in this population, leading to repeated trials of less effective medications. Current clozapine dosing recommendations are based on people further in the course of their illness and thus reflect different responsiveness and sensitivities to antipsychotic medication. As such, there is a need for evidence-based guidelines for titration and dosing of clozapine among people in early psychosis. METHODS/PROCEDURES:We performed a chart review of 14 people treated with clozapine within our early psychosis team. Data regarding dose titration, response, time to discontinuation, symptom severity, weight gain, and other adverse effects were gathered at clozapine initiation, 3 months, and last available visit on clozapine. FINDINGS/RESULTS:People treated with slow titration within their first year of psychosis onset achieved sustained response at very low maintenance doses (mean dose = 81 mg/d, mean duration of treatment = 200 weeks) compared with slow titration with longer duration of illness (mean dose = 350 mg/d, mean duration of treatment = 68 weeks) or standard dose titration in early psychosis (mean dose = 112 mg/d, mean duration of treatment = 38 weeks). The most common adverse effects in all groups were weight gain and sedation, with the groups requiring higher mean doses reporting a broader range of adverse effects. There was no apparent difference in the clinical global impression for severity or improvement between the slow titration and standard titration groups in people with early psychosis. These observations are synthesized into a proposed treatment guideline for use of clozapine among people in early psychosis. IMPLICATIONS/CONCLUSIONS:We describe development of a slow titration approach to initiating clozapine among people in early psychosis. This approach resulted in clinical response at remarkably low maintenance doses of clozapine among people within their first year of illness, but not in those with longer duration of symptoms. Slow titration also led to good tolerability and acceptance of clozapine treatment for some patients.

journal_name

J Clin Psychopharmacol

journal_title

Journal of clinical psychopharmacology

authors

Ballon JS,Ashfaq H,Noordsy DL

doi

10.1097/JCP.0000000000000860

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

234-238

issue

eissn

0271-0749

issn

1533-712X

pii

00004714-201806000-00012

journal_volume

pub_type

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Clozapine Titration for People in Early Psychosis: A Chart Review and Treatment Guideline.