An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels.

Details

Serval ID
serval:BIB_0D6FBF72C976
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels.
Journal
Pharmacopsychiatry
Author(s)
de Leon J., Schoretsanitis G., Smith R.L., Molden E., Solismaa A., Seppälä N., Kopeček M., Švancer P., Olmos I., Ricciardi C., Iglesias-Garcia C., Iglesias-Alonso A., Spina E., Ruan C.J., Wang C.Y., Wang G., Tang Y.L., Lin S.K., Lane H.Y., Kim Y.S., Kim S.H., Rajkumar A.P., González-Esquivel D.F., Jung-Cook H., Baptista T., Rohde C., Nielsen J., Verdoux H., Quiles C., Sanz E.J., De Las Cuevas C., Cohen D., Schulte PFJ, Ertuğrul A., Anıl Yağcıoğlu A.E., Chopra N., McCollum B., Shelton C., Cotes R.O., Kaithi A.R., Kane J.M., Farooq S., Ng C.H., Bilbily J., Hiemke C., López-Jaramillo C., McGrane I., Lana F., Eap C.B., Arrojo-Romero M., Rădulescu F.Ş., Seifritz E., Every-Palmer S., Bousman C.A., Bebawi E., Bhattacharya R., Kelly D.L., Otsuka Y., Lazary J., Torres R., Yecora A., Motuca M., Chan SKW, Zolezzi M., Ouanes S., De Berardis D., Grover S., Procyshyn R.M., Adebayo R.A., Kirilochev O.O., Soloviev A., Fountoulakis K.N., Wilkowska A., Cubała W.J., Ayub M., Silva A., Bonelli R.M., Villagrán-Moreno J.M., Crespo-Facorro B., Temmingh H., Decloedt E., Pedro M.R., Takeuchi H., Tsukahara M., Gründer G., Sagud M., Celofiga A., Ignjatovic Ristic D., Ortiz B.B., Elkis H., Pacheco Palha A.J., LLerena A., Fernandez-Egea E., Siskind D., Weizman A., Masmoudi R., Mohd Saffian S., Leung J.G., Buckley P.F., Marder S.R., Citrome L., Freudenreich O., Correll C.U., Müller D.J.
ISSN
1439-0795 (Electronic)
ISSN-L
0176-3679
Publication state
Published
Issued date
03/2022
Peer-reviewed
Oui
Volume
55
Number
2
Pages
73-86
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
This international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by 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, the lowest dose; male smokers, the highest dose). Poor metabolizer 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. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (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 with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.
Keywords
Adult, Antipsychotic Agents/adverse effects, Asians, C-Reactive Protein, Clozapine/adverse effects, Female, Humans, Male, Valproic Acid/adverse effects
Pubmed
Web of science
Open Access
Yes
Create date
20/12/2021 13:03
Last modification date
21/01/2023 7:46
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