Login Register Cart 0
Generic placeholder image

Current Drug Therapy

Editor-in-Chief

ISSN (Print): 1574-8855
ISSN (Online): 2212-3903

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Evaluation of Clozapine-induced Toxicities in Psychic Patients in Mental Health Care Hospitals in the Southern Region of the Saudi Arabia Kingdom

Author(s): Mohammed Zayed Alassiry, Yazeed Hussein Al-Jmaai, Ali Eissa Qhtani*, Mohammed Ayed Almushafi and Hassan Saeed Hassan

Volume 19, Issue 7, 2024

Published on: 01 January, 2024

Page: [863 - 877] Pages: 15

DOI: 10.2174/0115748855281044231206042618

Price: $65

Abstract

Background: Clozapine is a psychiatric medication that may cause various side effects, some of them may be serious and fatal adverse effects, such as severe neutropenia, agranulocytosis, lymphocytopenia, myocarditis, and orthostatic hypotension, that have been associated to an increased risk of death.

Objectives: This study aimed to evaluate the serious and potentially fatal adverse effects of clozapine toxicity in psychic patients at mental health care hospitals in the Southern region of the Kingdom of Saudi Arabia.

Methods: By using a survey, data were retrospectively collected from 193 adult psychic patient reports who have been administrated clozapine with regular follow-ups, in mental health hospitals in the Southern region of Saudi Arabia between 2019 and 2021. Then, these data are recorded and analyzed Statistically using SPSS software, with suitable tests, and predetermined statistical significance (p-value) of less than 0.001.

Results: The occurrence of agranulocytosis, neutropenia, hypotension, and seizures showed a highly significant correlation with higher doses of clozapine administration (i.e. p < 0.001). Similarly, agranulocytosis and neutropenia were significantly associated with the occurrence of both hypotension and seizures (i.e. p < 0.001).

Conclusion: The collected data in this study showed an increased incidence of agranulocytosis and neutropenia associated with clozapine-treated psychic patients in the Southern region of the Kingdom of Saudi Arabia which warrants further clinical studies to find this correlation.

« Previous Next »
Graphical Abstract

[1]
Stahl SM, Meyer JM. The clozapine handbook. Cambridge University Press 2020.
[2]
De Hert M, De Beugher A, Sweers K, Wampers M, Correll CU, Cohen D. Knowledge of psychiatric nurses about the potentially lethal side-effects of clozapine. Arch Psychiatr Nurs 2016; 30(1): 79-83.
[http://dx.doi.org/10.1016/j.apnu.2015.09.003] [PMID: 26804506]
[3]
Nielsen J, Correll CU, Manu P, Kane JM. Termination of clozapine treatment due to medical reasons: when is it warranted and how can it be avoided? J Clin Psychiatry 2013; 74(6): 603-13.
[http://dx.doi.org/10.4088/JCP.12r08064] [PMID: 23842012]
[4]
Grover S, Shouan A, Chakrabarti S, Avasthi A. Haematological side effects associated with clozapine: A retrospective study from India. Asian J Psychiatr 2020; 48: 101906.
[http://dx.doi.org/10.1016/j.ajp.2019.101906] [PMID: 31865196]
[5]
Li XH, Zhong XM, Lu L, et al. The prevalence of agranulocytosis and related death in clozapine-treated patients: A comprehensive meta-analysis of observational studies. Psychol Med 2020; 50(4): 583-94.
[http://dx.doi.org/10.1017/S0033291719000369] [PMID: 30857568]
[6]
Kang BJ, Cho MJ, Oh JT, Lee Y, Chae BJ, Ko J. Long‐term patient monitoring for clozapine‐induced agranulocytosis and neutropenia in Korea: when is it safe to discontinue CPMS? Hum Psychopharmacol 2006; 21(6): 387-91.
[http://dx.doi.org/10.1002/hup.779] [PMID: 16933201]
[7]
Fabrazzo M, Prisco V, Sampogna G, et al. Clozapine versus other antipsychotics during the first 18 weeks of treatment: A retrospective study on risk factor increase of blood dyscrasias. Psychiatry Res 2017; 256: 275-82.
[http://dx.doi.org/10.1016/j.psychres.2017.06.068] [PMID: 28651220]
[8]
Kishi T, Fujita K, Furukawa O, et al. Efficacy and tolerability of clozapine in Japanese patients with treatment-resistant schizophrenia: Results from a 12-week, flexible dose study using raters masked to antipsychotic choice. Asian J Psychiatr 2013; 6(3): 200-7.
[http://dx.doi.org/10.1016/j.ajp.2012.10.007] [PMID: 23642976]
[9]
Abanmy NO, Al-Jaloud A, Al-Jabr A, Al-Ruwaisan R, Al-Saeed W, Fatani S. Clozapine-induced blood dyscrasias in Saudi Arab patients. Int J Clin Pharm 2014; 36(4): 815-20.
[http://dx.doi.org/10.1007/s11096-014-9967-0] [PMID: 24917217]
[10]
Azorin JM, Spiegel R, Remington G, et al. A double-blind comparative study of clozapine and risperidone in the management of severe chronic schizophrenia. Am J Psychiatry 2001; 158(8): 1305-13.
[http://dx.doi.org/10.1176/appi.ajp.158.8.1305] [PMID: 11481167]
[11]
Merrill DB, Ahmari SE, Bradford JME, Lieberman JA. Myocarditis during clozapine treatment. Am J Psychiatry 2006; 163(2): 204-8.
[http://dx.doi.org/10.1176/appi.ajp.163.2.204] [PMID: 16449471]
[12]
Bhalke RD, Giri MA, Anil RY, Balasaheb NM, Nanasaheb PA, Pande VV. Hypotension: A comprehensive review. J Pharmacogn Phytochem 2021; 10(1): 1945-7.
[13]
Giourou E, Stavropoulou-Deli A, Giannakopoulou A, Kostopoulos G K, Koutroumanidis M. Introduction to epilepsy and related brain disorders. Cyberphysical systems for epilepsy and related brain disorders: Multi-parametric monitoring and analysis for diagnosis and optimal disease management 2015; 11-38.
[http://dx.doi.org/10.1007/978-3-319-20049-1_2]
[14]
Wright D G, Meierovics A I, Foxley JM. Assessing the delivery of neutrophils to tissues in neutropenia. Blood 67(4): 1023-30. 1986;
[15]
Pons A, Undurraga J, Batalla A, Bernardo M. [Clozapine and agranulocitosis in Spain: Do we have a safer population? A 5-year hematologic follow-up]. Rev Psiquiatr Salud Ment 2012; 5(1): 37-42.
[http://dx.doi.org/10.1016/j.rpsm.2011.11.003] [PMID: 22854502]
[16]
Balda MV, Garay OU, Papale RM, et al. Clozapine-associated neutropenia and agranulocytosis in Argentina (2007–2012). Int Clin Psychopharmacol 2015; 30(2): 109-14.
[http://dx.doi.org/10.1097/YIC.0000000000000060] [PMID: 25486383]
[17]
Mijovic A, MacCabe JH. Clozapine-induced agranulocytosis. Ann Hematol 2020; 99(11): 2477-82.
[http://dx.doi.org/10.1007/s00277-020-04215-y] [PMID: 32815018]
[18]
Ratanajamit C, Musakopas C, Vasiknanonte S, Reanmongkol W. Incidence and risk for neutropenia/agranulocytosis among clozapine users: A retrospective cohort study. Int J Psychiatry Clin Pract 2010; 14(2): 109-15.
[http://dx.doi.org/10.3109/13651500903402450] [PMID: 24922470]
[19]
Lee J, Takeuchi H, Fervaha G, et al. The effect of clozapine on hematological indices: A 1-year follow-up study. J Clin Psychopharmacol 2015; 35(5): 510-6.
[http://dx.doi.org/10.1097/JCP.0000000000000387] [PMID: 26267420]
[20]
Wiciński M, Węclewicz MM. Clozapine-induced agranulocytosis/granulocytopenia: Mechanisms and monitoring. Curr Opin Hematol 2018; 25(1): 22-8.
[http://dx.doi.org/10.1097/MOH.0000000000000391] [PMID: 28984748]
[21]
Pirmohamed M, Park K. Mechanism of clozapine-induced agranulocytosis: Current status of research and implications for drug development. CNS Drugs 1997; 7(2): 139-58.
[http://dx.doi.org/10.2165/00023210-199707020-00005] [PMID: 23338132]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy