Guía internacional para una dosificación más segura de la clozapina en adultos mediante el uso de 6 titulaciones personalizadas de dosis basados en la etnicidad, la proteína C reactiva y los niveles de clozapina

  1. de Leon, Jose
  2. Schoretsanitis, Georgios
  3. Smith, Robert L.
  4. Molden, Espen
  5. Solismaa, Anssi
  6. Seppälä, Niko
  7. Kopeček, Miloslav
  8. Švancer, Patrik
  9. Olmos, Ismael
  10. Ricciardi, Carina
  11. Iglesias-Garcia, Celso
  12. Iglesias-Alonso, Ana
  13. Spina, Edoardo
  14. Ruan, Can-Jun
  15. Wang, Chuan-Yue
  16. Wang, Gang
  17. Tang, Yi-Lang
  18. Lin, Shih-Ku
  19. Lane, Hsien-Yuan
  20. Kim, Yong Sik
  21. Kim, Se Hyun
  22. Rajkumar, Anto P.
  23. González-Esquivel, Dinora F.
  24. Jung-Cook, Helgi
  25. Baptista, Trino
  26. Rohde, Christopher
  27. Nielsen, Jimmi
  28. Verdoux, Hélène
  29. Quiles, Clelia
  30. Sanz, Emilio J.
  31. De las Cuevas, Carlos 1
  32. Cohen, Dan
  33. Schulte, Peter F.J.
  34. Ertuğrul, Aygün
  35. Anıl Yağcıoğlu, A. Elif
  36. Chopra, Nitin
  37. McCollum, Betsy
  38. Shelton, Charles
  39. Cotes, Robert O.
  40. Kaithi, Arun R.
  41. Kane, John M.
  42. Farooq, Saeed
  43. Ng, Chee H.
  44. Bilbily, John
  45. Hiemke, Christoph
  46. López-Jaramillo, Carlos
  47. McGrane, Ian
  48. Lana, Fernando
  49. Eap, Chin B.
  50. Arrojo-Romero, Manuel
  51. Rădulescu, Flavian Ştefan
  52. Seifritz, Erich
  53. Every-Palmer, Susanna
  54. Bousman, Chad A.
  55. Bebawi, Emmanuel
  56. Bhattacharya, Rahul
  57. Kelly, Deanna L.
  58. Otsuka, Yuji
  59. Lazary, Judit
  60. Torres, Rafael
  61. Yecora, Agustin
  62. Motuca, Mariano
  63. Chan, Sherry Kit Wa
  64. Zolezzi, Monica
  65. Ouanes, Sami
  66. De Berardis, Domenico
  67. Grover, Sandeep
  68. Procyshyn, Ric M.
  69. Adebayo, Richard A.
  70. Kirilochev, Oleg O.
  71. Soloviev, Andrey
  72. Fountoulakis, Konstantinos N.
  73. Wilkowska, Alina
  74. Cubała, Wiesław Jerzy
  75. Ayub, Muhammad
  76. Silva, Alzira
  77. Bonelli, Raphael M.
  78. Villagrán-Moreno, José María
  79. Crespo-Facorro, Benedicto
  80. Temmingh, Henk
  81. Decloedt, Eric
  82. Pedro, Maria Rosel
  83. Takeuchi, Hiroyoshi
  84. Tsukahara, Masaru
  85. Gründer, Gerhard
  86. Sagud, Marina
  87. Celofiga, Andreja
  88. Ignjatovic Ristic, Dragana
  89. Ortiz, Bruno Bertolucci
  90. Elkis, Helio
  91. Pacheco Palha, António José
  92. Llerena, Adrián
  93. Fernandez-Egea, Emilio
  94. Siskind, Dan
  95. Weizman, Abraham
  96. Masmoudi, Rim
  97. Mohd Saffian, Shamin
  98. Leung, Jonathan G.
  99. Buckley, Peter F.
  100. Marder, Stephen R.
  101. Citrome, Leslie
  102. Freudenreich, Oliver
  103. Correll, Christoph U.
  104. Müller, Daniel J.
  105. Alle Autoren anzeigen +
  1. 1 Universidad de La Laguna
    info

    Universidad de La Laguna

    San Cristobal de La Laguna, España

    ROR https://ror.org/01r9z8p25

Zeitschrift:
Psiquiatría Biológica

ISSN: 1134-5934

Datum der Publikation: 2023

Ausgabe: 30

Nummer: 3

Seiten: 100415

Art: Artikel

DOI: 10.1016/J.PSIQ.2023.100415 GOOGLE SCHOLAR lock_openOpen Access editor

Andere Publikationen in: Psiquiatría Biológica

Zusammenfassung

This is the Spanish translation of an international guideline which proposes improving clozapine package inserts worldwide by using ancestry-based: 1) dosing and 2) titration. Adverse drug reaction (ADR) databases suggest clozapine: 1) is the third most toxic drug in the United States (US), and 2) produces worldwide pneumonia mortality four times greater than that of agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers require the lowest dose and male smokers the highest dose). Poor metabolizer (PM) status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity or inflammation with C-reactive protein (CRP) elevations. People with ancestry from Asia (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/ml. Daily doses of 300-600 mg/day are recommended in the US. Slow personalized titration may prevent early ADRs (including syncope, myocarditis and pneumonia). The core of this guideline consists of six personalized titration schedules for inpatients: 1) Asian/Amerindian ancestry with lower metabolism (in cases of obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) Asian/Amerindian ancestry with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (in cases of obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US of non-Asian/Amerindian ancestry with lower clozapine metabolism (in cases of obesity or valproate) needing 150-300 mg/day, and 6) in the US of non-Asian/Amerindian ancestry with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least 4 weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.

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