Clozapine Rechallenge After Major Adverse Effects: Clinical Guidelines Based on 259 Cases

@article{Manu2018ClozapineRA,
  title={Clozapine Rechallenge After Major Adverse Effects: Clinical Guidelines Based on 259 Cases},
  author={Peter Manu and Yevgeniya Lapitskaya and Atef Shaikh and Jimmi Nielsen},
  journal={American Journal of Therapeutics},
  year={2018},
  volume={25},
  pages={e218–e223}
}
Background: Clozapine is widely prescribed for treatment-refractory schizophrenia, but its use is limited by many potentially life-threatening adverse effects. The risk of rechallenge after these complications has never been comprehensively assessed in controlled studies. Thus, clinical guidelines must rely on the published case reports. The number of such reports is likely to increase over time, and updated analyses of larger samples are needed, as they may lead to changes in clinical… Expand
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References

SHOWING 1-10 OF 84 REFERENCES
When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature
TLDR
Although controlled studies are clearly needed, using a priori, confidence interval-based criteria, case reports/series suggest that in refractory patients who benefited from clozapine, careful rechallenge can be considered after neutropenia and NMS, but not after agranulocytosis and myocarditis. Expand
Rechallenging with clozapine following neutropenia: treatment options for refractory schizophrenia.
TLDR
It is proposed that polypharmacy may have contributed to the initial episode of neutropenia as well as the failed clozapine rechallenge in a patient with refractory schizophrenia. Expand
Lithium and clozapine rechallenge: a retrospective case analysis.
TLDR
This study provides support for the utility of lithium in preventing neutropenias in rechallenge; extra vigilance may be required, however, to detect masked blood dyscrasias. Expand
Clozapine Rechallenge After Neutropenia or Leucopenia
TLDR
Almost 70% of the patients rechallenged with clozapine after a leucopenia or a neutropenia did not develop a new hematological adverse effect, whereas the remaining 30% had a faster but less serious neutropania. Expand
Optimizing outcomes in clozapine rechallenge following neutropenia: a cohort analysis.
TLDR
In this selected population, the initial neutropenia was unlikely to be related to clozapine in a substantial proportion of cases, and this group was successfully rechallenged following careful consideration of the risks and benefits. Expand
Successful rechallenge with clozapine after treatment associated eosinophilia
TLDR
It is believed that the current report provides further evidence that it may be unnecessary to cease treatment in all patients who develop an eosinophilia without organ dysfunction whilst on clozapine. Expand
Rechallenge with clozapine following leucopenia or neutropenia during previous therapy
TLDR
No clear risk factor for repeat blood dyscrasias was identified and after risks and benefits have been considered, rechallenge may well be justified in some patients. Expand
Development of Atrial Flutter After Initiation of Clozapine and Successful Rechallenge Without Recurrence.
TLDR
The case of a patient with newly developed atrial flutter after titration of clozapine in which the arrhythmia was medically managed to allow for successful rechallenge of clazapine is presented. Expand
Clozapine-induced interstitial nephritis - a rare but important complication: a case report
TLDR
A 57-year-old Caucasian woman with treatment-resistant chronic schizophrenia developed acute renal failure following initiation of treatment with clozapine, and Psychiatrists need to be aware of this possible complication when clozAPine is initiated. Expand
Successful Clozapine Rechallenge after Acute Myocarditis
  • A. Bray, R. Reid
  • Medicine
  • The Australian and New Zealand journal of psychiatry
  • 2011
TLDR
The patient is a 43-year-old man with schizophrenia, no prior cardiac disease, family history or cardiac risk factors, who had become resistant to non-clozapine antipsychotics, alone and in combination, over the twenty-year course of his illness. Expand
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