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Optimizing antidepressant and clozapine co-prescription in clinical practice: A systematic review and expert recommendations

dc.rights.licenseopenen_US
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorVERDOUX, Helene
dc.contributor.authorQUILES, Clelia
dc.contributor.authorDE LEON, Jose
dc.date.accessioned2024-01-08T13:52:20Z
dc.date.available2024-01-08T13:52:20Z
dc.date.issued2023-10-17
dc.identifier.issn1573-2509en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/186941
dc.description.abstractEnOBJECTIVES: To synthesize the information relevant for clinical practice on clozapine-antidepressant co-prescription concerning pharmacokinetic drug-drug interactions (DDI), adverse drug reactions (ADRs) associated with the co-prescription, antidepressant add-on for clozapine-resistant symptoms and antidepressant add-on for clozapine-induced ADRs. METHODS: Articles were identified with MEDLINE, Web of Sciences and PsycINFO search from inception through April 2023. Data were synthesized narratively. RESULTS: ADRs are most often induced by the co-prescription of antidepressants that inhibit CYP enzymes (fluvoxamine, fluoxetine, paroxetine). Fluvoxamine add-on is hazardous because of its potent inhibition of clozapine metabolism and has few indications (lowering daily number of clozapine tablets, reducing norclozapine-induced metabolic disturbances and other dose-dependent clozapine-induced ADRs). ADR frequency may be reduced by therapeutic drug monitoring and knowledge of other factors impacting clozapine metabolism (pneumonia, inflammation, smoking, etc.). Improvement of negative symptoms is the most documented beneficial effect of antidepressant add-on for clozapine-resistant psychotic symptoms. The add-on antidepressant should be chosen according to its safety profile regarding DDI with clozapine: antidepressants inhibiting clozapine metabolism or increasing the anticholinergic load should be avoided. Other indications of antidepressant add-on (affective or obsessive compulsive symptoms, sialorrhea, and enuresis) are poorly documented. CONCLUSION: Antidepressant add-on to clozapine is associated with potential benefits in clozapine users as this strategy may contribute to reduce the burden of clozapine-resistant symptoms or of clozapine-induced ADRs. Further studies are needed to determine whether antidepressant add-on can reduce the risk of clozapine discontinuation.
dc.language.isoENen_US
dc.subject.enAdverse drug reaction
dc.subject.enAntidepressant
dc.subject.enClozapine
dc.subject.enDrug-drug interaction
dc.title.enOptimizing antidepressant and clozapine co-prescription in clinical practice: A systematic review and expert recommendations
dc.title.alternativeSchizophr Resen_US
dc.typeArticle de revue
dc.identifier.doi10.1016/j.schres.2023.10.003en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed37852856en_US
bordeaux.journalSchizophrenia researchen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamAHEAD_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-04379636
hal.version1
hal.date.transferred2024-01-08T13:52:21Z
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Schizophrenia%20research&rft.date=2023-10-17&rft.eissn=1573-2509&rft.issn=1573-2509&rft.au=VERDOUX,%20Helene&QUILES,%20Clelia&DE%20LEON,%20Jose&rft.genre=article


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