The clinical potentials of adjunctive fluvoxamine to clozapine treatment: a systematic review

@article{Polcwiartek2015TheCP,
  title={The clinical potentials of adjunctive fluvoxamine to clozapine treatment: a systematic review},
  author={C. Polcwiartek and J. Nielsen},
  journal={Psychopharmacology},
  year={2015},
  volume={233},
  pages={741-750}
}
RationaleNew clozapine optimization strategies are warranted, as some patients do not achieve sufficient response and experience various adverse effects. Fluvoxamine is a potent CYP1A2 inhibitor and may increase the ratio of clozapine to its primary metabolite N-desmethylclozapine (NDMC).ObjectivesThis study aims to review all pharmacodynamic effects and the adverse effect profile of changing the clozapine/NDMC ratio with adjunctive fluvoxamine.MethodsMEDLINE, Embase, and the Cochrane Library… Expand
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References

SHOWING 1-10 OF 59 REFERENCES
Adjunctive fluvoxamine inhibits clozapine-related weight gain and metabolic disturbances.
TLDR
It is suggested that fluvoxamine cotreatment can attenuate weight gain and metabolic disturbances in clozapine-treated patients and conservative introduction with reduced clozabine dosage and careful therapeutic drug monitoring of clozAPine concentration is recommended. Expand
Fluvoxamine reduces the clozapine dosage needed in refractory schizophrenic patients.
TLDR
The addition of fluvoxamine, 50 mg/day, to low-dose clozapine, 100 mg/ day, can raise plasma clozAPine levels to at least 300 ng/mL in most patients, and this drug combination was well tolerated, and clinical improvement was observed in patients. Expand
Fluvoxamine Inhibition and Carbamazepine Induction of the Metabolism of Clozapine: Evidence from a Therapeutic Drug Monitoring Service
TLDR
It is concluded that carbamazepine causes decreased clozapine plasma levels, while fluvoxamine increases the levels. Expand
Addition of low-dose fluvoxamine to low-dose clozapine monotherapy in schizophrenia: drug monitoring and tolerability data from a prospective clinical trial.
TLDR
Though the addition of fluvoxamine to clozapine medication was well tolerated and critical side effects were absent, the combined treatment should be controlled by drug monitoring, as serum concentrations of clozAPine increased to unpredictably high levels. Expand
Increasing the clozapine: norclozapine ratio with co-administration of fluvoxamine to enhance efficacy and minimize side effects of clozapine therapy.
TLDR
It is hypothesize that co-administration of clozapine and fluvoxamine at dosages that will produce therapeutic plasma levels ofClozapines and a clozabine: norclozAPine ratio of two or more will increase efficacy and tolerability of clazapine therapy in treatment-resistant schizophrenic patients. Expand
Olanzapine plus fluvoxamine and olanzapine alone for the treatment of an acute exacerbation of schizophrenia
TLDR
Fluvoxamine augmentation to olanzapine is well tolerated and more effective than olanZapine alone for short‐term (6‐week) treatment of an acute exacerbation of schizophrenia. Expand
Termination of clozapine treatment due to medical reasons: when is it warranted and how can it be avoided?
TLDR
Results suggest that prompt discontinuation of clozapine without rechallenge is indicated for agranulocytosis, myocarditis, cardiomyopathy, and a QTc interval > 500 milliseconds that is confirmed and derived using the appropriate correction method. Expand
Clozapine treatment of childhood-onset schizophrenia: evaluation of effectiveness, adverse effects, and long-term outcome.
TLDR
Clinical improvement after 6 weeks of clozapine treatment, as measured by the percentage of improvement on the Brief Psychiatric Rating Scale and the Scale for the Assessment of Positive Symptoms, was strongly associated with the NDMC/clozAPine ratio at the 6-week time point. Expand
Pharmacokinetic interactions of clozapine with selective serotonin reuptake inhibitors: differential effects of fluvoxamine and paroxetine in a prospective study.
TLDR
In all patients, fluvoxamine induced relevant increases in serum concentrations ofClozapine and its metabolites, probably by the inhibition of enzymes catalyzing the degradation of clozapines and N-desmethylclozabine, whereas paroxetine, at a usual clinically effective dosage of 20 mg/day, did not cause significant pharmacokinetic interactions. Expand
Fluvoxamine Augmentation of Olanzapine in Chronic Schizophrenia: Pharmacokinetic Interactions and Clinical Effects
TLDR
Although the combination was well tolerated in this sample and the negative symptom response appeared to be favorable in at least five patients, the combination therapy of olanzapine and fluvoxamine should be used cautiously and should be controlled by therapeutic drug monitoring to avoid olanZapine-induced side effects or intoxications. Expand
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