Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

作者：Domenico De Berardis, Gabriella Rapini, Luigi Olivieri, Domenico Di Nicola, Carmine Tomasetti, Alessandro Valchera, Michele Fornaro, Fabio Di Fabio, Giampaolo Perna, Marco Di Nicola, Gianluca Serafini, Alessandro Carano, Maurizio Pompili, Federica Vellante, Laura Orsolini, Giovanni Martinotti, Massimo Di Giannantonio · 发表于：Therapeutic Advances in Drug Safety · 年份：2018 · DOI：10.1177/2042098618756261 · 被引用次数：209 · 研究领域：Schizophrenia research and treatment、Bipolar Disorder and Treatment、Electroconvulsive Therapy Studies

Clozapine, a dibenzodiazepine developed in 1961, is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. Since its introduction, it has remained the drug of choice in treatment-resistant schizophrenia, despite a wide range of adverse effects, as it is a very effective drug in everyday clinical practice. However, clozapine is not considered as a top-of-the-line treatment because it may often be difficult for some patients to tolerate as some adverse effects can be particularly bothersome (i.e. sedation, weight gain, sialorrhea etc.) and it has some other potentially dangerous and life-threatening side effects (i.e. myocarditis, seizures, agranulocytosis or granulocytopenia, gastrointestinal hypomotility etc.). As poor treatment adherence in patients with resistant schizophrenia may increase the risk of a psychotic relapse, which may further lead to impaired social and cognitive functioning, psychiatric hospitalizations and increased treatment costs, clozapine adverse effects are a common reason for discontinuing this medication. Therefore, every effort should be made to monitor and minimize these adverse effects in order to improve their early detection and management. The aim of this paper is to briefly summarize and provide an update on major clozapine adverse effects, especially focusing on those that are severe and potentially life threatening, even if most of the latter are relatively uncommon.