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

Domenico De Berardis*, Gabriella Rapini, Luigi Olivieri, Domenico Di Nicola, Carmine Tomasetti, Alessandro Valchera, Michele Fornaro, Fabio Di Fabio, Giampaolo Perna, Marco Di Nicola, Gianluca Serafini, Alessandro Carano, Maurizio Pompili, Federica Vellante, Laura Orsolini, Giovanni Martinotti, Massimo Di Giannantonio

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

89 Citations (Web of Science)

Abstract

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.
Original languageEnglish
Pages (from-to)237-256
Number of pages20
JournalTherapeutic Advances in Drug Safety
Volume9
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • adverse effects
  • clozapine
  • life threatening
  • management
  • resistant schizophrenia
  • NEUROLEPTIC MALIGNANT SYNDROME
  • INDUCED GASTROINTESTINAL HYPOMOTILITY
  • TREATMENT-RESISTANT SCHIZOPHRENIA
  • COLONY-STIMULATING FACTOR
  • INDUCED WEIGHT-GAIN
  • TORSADE-DE-POINTES
  • INDUCED AGRANULOCYTOSIS
  • 2ND-GENERATION ANTIPSYCHOTICS
  • INDUCED MYOCARDITIS
  • IN-VITRO

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