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Prescribing trends and safety of clozapine in an older persons mental health population

Published online by Cambridge University Press:  21 March 2019

Alice Law  and
Matthew Croucher
Alice Law*
Affiliation:
Psychiatrist of Old Age, Mental Health Service for Older People (MHSOP), Taranaki District Health Board, New Plymouth, New Zealand
Matthew Croucher
Affiliation:
Psychiatrist of Old Age, Older Persons Health Specialist Service (OPHSS), Canterbury District Health Board, Christchurch, New Zealand
*
Correspondence should be addressed to: Alice Law, Psychiatrist of Old Age, Mental Health Service for Older People (MHSOP), Taranaki District Health Board, Private Bag 2016, New Plymouth 4342, New Zealand. Phone: +64 6 753 6139 ext 7620; Fax: +64 6 753 7796. Email: alice.law@tdhb.org.nz.
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Abstract

Objectives:

To provide additional data concerning the safety, effectiveness and local prescribing trends of clozapine in elderly patients.

Design:

Retrospective observational case-series analysis.

Setting:

Data were collected from the medical files of 167 patients prescribed clozapine.

Participants:

All patients prescribed clozapine in the last 15 years by the psychogeriatric service in Christchurch, New Zealand. The subjects were mostly aged over 65; however, patients under 65 are also accepted into the service on a case by case basis if they have an age-related health condition.

Results:

Twenty-five (15.0%) patients had their clozapine stopped due to a significant adverse reaction, including eleven who developed significant neutropenia. Seventy-four (44.3%) of the patients had no recorded side effects at all. Sixty-five (38.9%) of our elderly patients died while taking clozapine, though none of these deaths was felt to be related to clozapine use. Several patients safely initiated clozapine in either their own home or a nursing home without requiring hospital admission. Only two patients ceased clozapine due to ineffectiveness, and one hundred, forty-two (86.1%) of the patients had positive comments in their medical record regarding the benefits of clozapine for their particular case.

Conclusions:

We found clozapine could be used safely and effectively in our patient group, for a wider range of indications and at lower doses than younger patients. Data collection regarding cause of death in elderly patients who were ever prescribed clozapine was problematic, and more research into this area is required.

Keywords

Clozapineelderlymedicationadverse effectsagranulocytosispsychosisantipsychotic
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 12: Issue Theme: Assessment of Cognitive Impairment in East Asia , December 2019 , pp. 1823 - 1829
Copyright
© International Psychogeriatric Association 2019 

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References

Alvir, J. M., Lieberman, J. A., Safferman, A. Z., Schwimmer, J. L. and Schaaf, J. A. (1993). Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. New England Journal of Medicine, 329, 162–167.CrossRefGoogle ScholarPubMed
Asenjo Lobos, C. et al. (2010). Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews, [online] 11, CD006633. Available at: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006633.pub2/full Google Scholar
Barak, Y., Wittenberg, N., Naor, S., Kutzuk, D. and Weizman, A. (1999). Clozapine in elderly psychiatric patients: Tolerability, safety and efficacy. Comprehensive Psychiatry, 40, 320–325.CrossRefGoogle ScholarPubMed
Douglas Pharmaceuticals Ltd (2010). Clopine tablets data sheet [online]. Auckland, NZ: Douglas Pharmaceuticals Ltd. Available at: http://www.medsafe.govt.nz/profs/Datasheet/c/Clopinetaboralsuspen.pdf; [updated Jul 2017; cited 2018 Jul 4].Google Scholar
Essali, A., Al-Haj Haasan, N. A., Li, C. and Rathbone, J. (2009). Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database of Systematic Reviews, [online] 1, CD000059. Available at: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD000059.pub2/full Google Scholar
Every-Palmer, S. and Ellis, P. M. (2017). Clozapine induced gastrointestinal hypo motility: A 22 year Bi-national pharmacovigilance study of serious or fatal ‘slow gut’ reactions and comparison with international drug safety advice. CNS Drugs, 31, 699–709.CrossRefGoogle ScholarPubMed
Frankenburg, F. R. and Kalunian, D. (1994). Clozapine in the elderly. Journal of Geriatric Psychiatry and Neurology, 7, 129–132.CrossRefGoogle ScholarPubMed
Galletly, C. et al. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry, 50, 410–472.CrossRefGoogle ScholarPubMed
Gareri, P., De Fazio, P., Russo, E., Marigliano, N., De Fazio, S. and De Sarro, G. (2008). The safety of clozapine in the elderly. Expert Opinion on Drug Safety, 7, 525–538.CrossRefGoogle ScholarPubMed
Gören, J. L. et al. (2013). Antipsychotic prescribing pathways, polypharmacy, and clozapine use in treatment of schizophrenia. Psychiatric Services, 64, 527–533.CrossRefGoogle ScholarPubMed
Guenette, M. D. et al. (2013). Risk of neutropenia in a clozapine-treated elderly population. Schizophrenia Research, 148, 183–185.CrossRefGoogle Scholar
Hennen, J. and Baldessarini, R. J. (2005). Suicidal risk during treatment with clozapine: A meta-analysis. Schizophrenia Research, 73, 139–145.CrossRefGoogle ScholarPubMed
Herst, L. and Powell, G. (1997). Is clozapine safe in the elderly? Australian and New Zealand Journal of Psychiatry, 31, 411–417.CrossRefGoogle ScholarPubMed
Hildrum, B., Mykletun, A., Hole, T., Midthjell, K. and Dahl, A. A. (2007). Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: The Norwegian HUNT 2 study. BMC Public Health, 7, 220.CrossRefGoogle ScholarPubMed
Kiviniemi, M., Suvisaari, J., Koivumaa-Honkanen, H., Häkkinen, U., Isohanni, M. and Hakko, H. (2013). Antipsychotics and mortality in first-onset schizophrenia: Prospective Finnish register study with 5-year follow-up. Schizophrenia Research, 150, 274–280.CrossRefGoogle ScholarPubMed
Lamberti, J.S. et al. (2006). Prevalence of the metabolic syndrome among patients receiving clozapine. The American Journal of Psychiatry, 163, 1273–1276.CrossRefGoogle ScholarPubMed
Leucht, S. et al. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. Lancet, 382, 951–962.CrossRefGoogle ScholarPubMed
Marriott, R., Neil, W. and Waddingham, S. (2006). Antipsychotic medication for elderly people with schizophrenia. Cochrane Database of Systematic Reviews, [online] 1, CD005580. Available at: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005580/full CrossRefGoogle Scholar
Nielsen, J., Correll, C. U., Manu, P. and Kane, J. M. (2013). Termination of clozapine treatment due to medical reasons: When is it warranted and how can it be avoided? The Journal of Clinical Psychiatry, 74, 603–613.CrossRefGoogle ScholarPubMed
Palmer, S. E., Mclean, R. M., Ellis, P. M. and Harrison-Woolrych, M. (2008). Life-threatening clozapine-induced gastrointestinal hypo motility: An analysis of 102 cases. The Journal of Clinical Psychiatry, 69, 759–768.CrossRefGoogle Scholar
Paranthaman, R. and Baldwin, R. C. (2006). Survey of clozapine use by consultant old age psychiatrists. Psychiatric Bulletin, 30, 410–412.CrossRefGoogle Scholar
Pitner, J. K., Mintzer, J. E., Pennypacker, L. C. and Jackson, C. W. (1995). Efficacy and adverse effects of clozapine in four elderly psychotic patients. The Journal of Clinical Psychiatry, 56, 180–185.Google ScholarPubMed
Pridan, S., Swartz, M., Baruch, Y., Tadger, S., Plopski, I. and Barak, Y. (2015). Effectiveness and safety of clozapine in elderly patients with chronic resistant schizophrenia. International Psychogeriatrics, 27, 131–134.CrossRefGoogle ScholarPubMed
Ray, W. A., Chung, C. P., Murray, K. T., Hall, K. and Stein, C. M. (2009). Atypical antipsychotic drugs and the risk of sudden cardiac death. New England Journal of Medicine, 360, 225–235.CrossRefGoogle ScholarPubMed
Sajatovic, M., Jaskiw, G., Konicki, P. E., Jurjus, G., Kwon, K. and Ramirez, L. F. (1996). Outcome of clozapine therapy for elderly patients with refractory primary psychosis. International Journal of Geriatric Psychiatry, 12, 553–558.3.0.CO;2-U>CrossRefGoogle Scholar
Salzman, C., Vaccaro, B., Lieff, J. and Weiner, A. (1995). Clozapine in older patients with psychosis and behavioural disruption. The American Journal of Geriatric Psychiatry, 3, 26–33.CrossRefGoogle Scholar
Schneeweiss, S., Setoguchi, S., Brookhart, A., Dormuth, C. and Wang, P. S. (2007). Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. Canadian Medical Association Journal, 176, 627–632.CrossRefGoogle ScholarPubMed
Shin, J. Y., Choi, N. K., Jung, S. Y., Lee, J., Kwon, J. S. and Park, B. J. (2013). Risk of ischemic stroke with the use of risperidone, quetiapine and olanzapine in elderly patients: A population-based, case-crossover study. Journal of Psychopharmacology, 27, 638–644.CrossRefGoogle ScholarPubMed
Shulman, R. W., Singh, A. and Shulman, K. I. (1997). Treatment of elderly institutionalised patients with clozapine. Psychopharmacology Bulletin, 33, 113–118.Google Scholar
Snowdon, J. and Halliday, G. (2011). A study of the use of clozapine in old age psychiatry. International Clinical Psychopharmacology, 26, 232–235.CrossRefGoogle ScholarPubMed
Tolppanen, A.M. et al. (2016). Antipsychotic use and risk of hospitalisation or death due to pneumonia in persons with and without Alzheimer’s disease. Chest, 150, 1233–1241.CrossRefGoogle ScholarPubMed
Walker, A. M., Lanza, L. L., Arellano, F. and Rothman, K. J. (1997). Mortality in current and former users of clozapine. Epidemiology, 8, 671–677.CrossRefGoogle ScholarPubMed