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Clozapine serum levels

Mijeong Kang, Eunkyoung Kim, Thomas E Winkler, George Banis, Yi Liu, Christopher A Kitchen, Deanna L Kelly, Reza Ghodssi, Gregory F Payne
Clozapine is one of the most promising medications for managing schizophrenia but it is under-utilized because of the challenges of maintaining serum levels in a safe therapeutic range (1-3μM). Timely measurement of serum clozapine levels has been identified as a barrier to the broader use of clozapine, which is however challenging due to the complexity of serum samples. We demonstrate a robust and reusable electrochemical sensor with graphene-chitosan composite for rapidly measuring serum levels of clozapine...
September 15, 2017: Biosensors & Bioelectronics
Katalin Tóth, Gábor Csukly, Dávid Sirok, Ales Belic, Ádám Kiss, Edit Háfra, Máté Déri, Ádám Menus, István Bitter, Katalin Monostory
Background: The atypical antipsychotic clozapine is effective in treatment-resistant schizophrenia; however, the success or failure of clozapine therapy is substantially affected by the variables that impact the clozapine blood concentration. Thus, elucidating the inter-individual differences in clozapine pharmacokinetics can facilitate the personalized therapy. Methods: Since potential role in clozapine metabolism is assigned to CYP1A2, CYP2C19, CYP2D6 and CYP3A enzymes, the association between the patients' CYP-status (CYP genotypes, CYP expression) and clozapine clearance was evaluated in 92 psychiatric patients...
March 18, 2017: International Journal of Neuropsychopharmacology
Michał Wiciński, Mateusz M Węclewicz, Mateusz Miętkiewicz, Bartosz Malinowski, Elżbieta Grześk, Joanna Klonowska
Clozapine is a second-generation antipsychotic which has proven efficacy in treating the symptoms of schizophrenia. Although clozapine therapy is associated with a number of adverse drug reactions, it is frequently used. One of the most common adverse drug reactions is gastroesophageal reflux disease which is an indication for treatment with proton pump inhibitors (PPIs). Coadministration of clozapine and PPIs increases the risk of hematological adverse drug reactions, including neutropenia and agranulocytosis...
March 2017: Journal of Psychiatric Practice
Alper Bas, Gozde Gultekin, Said Incir, Tuba Ocek Bas, Murat Emul, Alaatin Duran
Thioredoxin is a serum antioxidant that has been investigated in the etiology of schizophrenia. The aim of this study is investigating the relationship between serum thioredoxin levels and cognitive functions in acute psychotic episode and remission state patients with schizophrenia; and examining whether there were differences between patients using clozapine and other atypical antipsychotics; including risperidone, olanzapine and amisulpride. This research was performed in schizophrenia patients hospitalized with acute psychotic episode (n=57), reevaluated patients after the initiation of treatment (mean 16 weeks) (n=46), and healthy controls (n=41)...
January 2017: Psychiatry Research
Vassiliki A Boumba, George Rallis, Petros Petrikis, Theodore Vougiouklakis, Venetsanos Mavreas
In this study, we describe a simple and rapid method for the determination of the antipsychotic drug clozapine and five commonly co-administered antidepressants - bupropion, mirtazapine, sertraline, clomipramine and citalopram - in serum, plasma and whole blood. Sample preparation includes solid phase extraction of analytes and determination of drug concentrations by gas chromatography-mass spectrometry without any derivatization steps. The method was fully validated according to international criteria and can be successfully applied for routine analyses...
December 1, 2016: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Jari-Pekka Klemettilä, Olli Kampman, Niko Seppälä, Merja Viikki, Mari Hämäläinen, Eeva Moilanen, Esa Leinonen
BACKGROUND: Schizophrenia is associated with excess cardiovascular comorbidity and mortality related to lifestyle factors, such as lack of physical activity, poor diet, and smoking. The prevalence of metabolic syndrome is increased among patients with schizophrenia, with the highest rates among patients on clozapine treatment. Smoking, obesity, physical inactivity, airway inflammation and obstruction, and adipose tissue and inflammatory marker activation are related in systemic inflammation...
February 2017: Nordic Journal of Psychiatry
Narjes Hendouei, Seyed Hamzeh Hosseini, Amin Panahi, Zahra Khazaeipour, Fatemeh Barari, Adeleh Sahebnasagh, Shahram Ala
Recently, extensive efforts have been made to understand the rate of energy expenditure and the weight gain associated with atypical antipsychotic treatment, including identification of markers of obesity risk. In recent years, leptin, an adipocyte hormone, has gained significant interest in psychiatric disorders. S100B has been considered as a surrogate marker for astrocyte-specific damage in neurologic disorders. Also, S100B has been detected in adipose with concentration as high as nervous tissue as a second release source...
2016: Iranian Journal of Pharmaceutical Research: IJPR
Trehani M Fonseka, Daniel J Müller, Sidney H Kennedy
Antipsychotic medications (APs), particularly second-generation APs, are associated with significant weight gain in schizophrenia patients. Recent evidence suggests that the immune system may contribute to antipsychotic-induced weight gain (AIWG) via AP-mediated alterations of cytokine levels. Antipsychotics with a high propensity for weight gain, such as clozapine and olanzapine, influence the expression of immune genes, and induce changes in serum cytokine levels to ultimately down-regulate neuroinflammation...
May 2016: Molecular Neuropsychiatry
Yu-Chi Huang, Pao-Yen Lin, Yu Lee, Chih-Ching Wu, Su-Ting Hsu, Chi-Fa Hung, Chien-Chih Chen, Mian-Yoon Chong, Chieh-Hsin Lin, Liang-Jen Wang
The disturbances of β-hydroxybutyrate (β-HB) and pyruvate are linked with impaired brain energy utilization which involves in the psychopathology of schizophrenia. This study investigates the difference in levels of β-HB and pyruvate between patients with schizophrenia and healthy controls, and explores their relationship with metabolic profiles and disease characteristics. We recruited 54 physically-health schizophrenic patients and 54 age- and gender-matched healthy control subjects. Blood samples were gathered to determine the serum levels of β-HB and pyruvate and plasma levels of metabolic profiles, including fasting glucose, triglycerides, total cholesterol, high- and low-density lipoprotein-cholesterol and adiponectin...
November 2016: Psychoneuroendocrinology
Christopher Wohkittel, Manfred Gerlach, Regina Taurines, Christoph Wewetzer, Stefan Unterecker, Rainer Burger, Diana Schreck, Claudia Mehler-Wex, Marcel Romanos, Karin Egberts
Information on dose- and concentration-related clinical effects of clozapine treatment in children and adolescents is scarce. This study aimed to examine the relationship between dose, serum concentration, and clinical outcome as well as the influencing factors thereof in paediatric patients treated with clozapine. Data from a routine Therapeutic Drug Monitoring (TDM) service between 2004 and 2014 were studied in 68 patients, aged 11-18 years. Severity of illness, therapeutic effectiveness and adverse drug reactions (ADRs) were assessed by standardized means...
August 2016: Journal of Neural Transmission
T S E Nonner, S J Timmer
Electronic cigarettes are becoming increasingly popular and therefore psychiatrists are being confronted more and more frequently by this relatively new phenomenon. We discuss the case of a patient who switched from traditional cigarettes to electronic cigarettes and thereupon had a significant increase in the clozapine serum level. The increased level led to considerable side-effects and, as a result, the patients clozapine dosage had to be reduced. In theory, a rise in the clozapine serum level is to be expected after such a switch...
2016: Tijdschrift Voor Psychiatrie
Ian J Osborne, Ronan J McIvor
We describe the case of a young man with treatment-resistant schizophrenia, who developed myoclonus during clozapine titration. This subsequently led to a full tonic-clonic seizure. Clozapine treatment can result in a range of seizure-like activity, the most well-known being tonic-clonic seizures. This case highlights the importance of recognizing and treating clozapine-induced myoclonus, as it can herald the onset of a full seizure, even at low serum clozapine levels. We highlight the variety of ways myoclonus can present clinically and suggest treatment options...
December 2015: Therapeutic Advances in Psychopharmacology
S V Sathish Kumar, Vinod Kumar Sinha
BACKGROUND: Sexual dysfunctions have been a major side effect of the second generation anti-psychotic drugs which often affects treatment compliance in patients with schizophrenia. There is no/few systematic review or research addressing sexual dysfunction and their effect on serum prolactin level among different atypical antipsychotics in India. AIMS: To determine and compare the frequency of sexual dysfunction associated with olanzapine, risperidone, and clozapine and their effect on serum prolactin level in remitted patients with schizophrenia...
October 2015: Indian Journal of Psychiatry
Udo Bonnet, Behnaz Taazimi, Martin Montag, Regine Ronge, Holger Gespers, Ralf Kuhlmann, Dieter Grabbe, Jürgen Jahn
No abstract text is available yet for this article.
December 2015: Psychiatria Danubina
C Zhang, Y Zhang, J Cai, M Chen, L Song
Metabolic syndrome (MetS) is considered to be an adverse effect of long-term treatment with atypical antipsychotics, particularly clozapine. There is strong evidence that the activation of inflammatory pathways interferes with normal metabolism and contributes to the development of MetS. C3, which is an inflammation molecule, has been reported to be associated with MetS. Because C3 is a heritable trait, we accordingly hypothesized that the gene encoding C3 (C3) would be a candidate gene for inter-individual variation in clozapine-induced MetS...
October 27, 2015: Pharmacogenomics Journal
E M ten Bokum, H L A van de Oever, D W S Radstake, M E L Arbouw
We report on a patient on clozapine treatment who was admitted to our hospital with pneumonia. He had stopped smoking a few weeks before admission. The serum clozapine rose to a toxic level, most likely due to the combination of infection and smoking cessation. Physicians and pharmacists are often not aware of risk factors for decreased metabolism of clozapine.
August 2015: Netherlands Journal of Medicine
Varun Gupta, Rohit Goyal, Pyare Lal Sharma
BACKGROUND: Ischemic preconditioning (IPC) induced cardioprotection has been reported to be blunted in hyperlipidemic subjects. Dopamine, via its D2 receptor signaling, appears to mimic the signaling cascade involved in myocardial preconditioning and is also involved in the inhibition of hyperlipidemia induced mediators. The present study was designed to investigate the possible involvement of D2 receptors in IPC and to see whether dopamine preconditioning can offer cardioprotection in hyperlipidemic rat hearts...
2015: BMC Cardiovascular Disorders
E J J Lisette Berm, Rianne Ruijsbroek, Anton J M Loonen, Kris R Goethals, Bob Wilffert, Fenneke van Hasselt
BACKGROUND: Cytochrome P450 subtype 1A2 (CYP1A2) is responsible for the metabolism of several drugs, including the antipsychotic agent clozapine. Smoking cigarettes induces CYP1A2. Due to this induction, a higher dosage of the drug is required by patients who smoke tobacco. CASE DESCRIPTION: The dosage of clozapine was changed for a 34-year-old male because of suspected active psychosis. However, serum levels of clozapine did not change according to expectations...
2015: Nederlands Tijdschrift Voor Geneeskunde
Paria Hebrani, Ali Akhoundpour Manteghi, Fatemeh Behdani, Elham Hessami, Kambiz Akhavan Rezayat, Majid Nabizadeh Marvast, Amir Akhavan Rezayat
BACKGROUND: One of the major causes of death in schizophrenia is a metabolic syndrome. The clozapine has the highest rate of weight gain among antipsychotics. It has been shown that metformin can promote weight loss. We aimed to investigate the effect of metformin as an adjunctive therapy with clozapine to prevent metabolic syndrome in patients with schizophrenia. MATERIALS AND METHODS: A total of 37 patients consisting metformin group (19 cases) and a group of placebo consisting of 18 cases were evaluated...
April 2015: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
Martina Curto, Anna Comparelli, Giuseppino M Ciavarella, Carlotta Gasperoni, Luana Lionetto, Valentina Corigliano, Arianna Uccellini, Iginia Mancinelli, Stefano Ferracuti, Paolo Girardi, Ross J Baldessarini
This preliminary prospective study evaluated cardiac status in 15 treatment-resistant schizophrenia patients (aged 18-55 years) without evidence of cardiovascular disease. Patients underwent clinical assessment, blood tests, ECG, and echocardiography before and during clozapine treatment for 4 weeks as doses increased from 25 to 100 mg/day. Serum concentrations of high-sensitivity C-reactive protein, troponin-I, brain natriuretic peptide, and clozapine+norclozapine were assayed at week 3; ECG and echocardiography were repeated at week 4...
September 2015: International Clinical Psychopharmacology
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