Is there a way to overcome oversedation in a patient being treated with clozapine?
Abstract
The pharmacologic management of schizophrenia has changed over the past decade through the introduction of new medications with generally fewer side effects than the older antipsychotics. Unfortunately, some patients do not respond to the second-generation antipsychotics. In this situation, a trial of clozapine may be undertaken. However, although schizophrenic symptoms may be alleviated, the patients often continue to suffer psychologically and socially because of the side effects of clozapine. One of these so-called “nuisance” side effects is sedation, and one result of oversedation is an inability to participate in rehabilitation programs aimed at improving social skills, social integration and interpersonal relationships.
Coincidentally, there has been an increase in our understanding of the role of cytochrome P450 (CYP) enzymes in the mechanisms of the side effects related to concomitant use of medications. For example, an increase in the serum concentration of clozapine is a well-known result of concomitant use of fluvoxamine. This effect is believed to result from inhibition of the activity of CYP1A2 by fluvoxamine and can lead to concentration-dependent clozapine-related side effects such as sedation, orthostatic hypotension and seizures.
Although interactions between medications at the level of the CYPs are viewed primarily in the context of negative treatment outcomes, it may be possible to exploit such interactions for the benefit of patients. Two recent reports…
Read the paper
Related studies
- The neurocircuitry of addiction: an overview
- Gender Differences in Human Brain: A Review
- Stratified medicine for mental disorders
- The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex
- Annual Research Review: DNA methylation as a mediator in the association between risk exposure and child and adolescent psychopathology
- Schizophrenia: The new etiological synthesis
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.