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

dc.rights.licenseopenen_US
dc.contributor.authorDE LEON, Jose
dc.contributor.authorSCHORETSANITIS, Georgios
dc.contributor.authorSMITH, Robert L.
dc.contributor.authorMOLDEN, Espen
dc.contributor.authorSOLISMAA, Anssi
dc.contributor.authorSEPPALA, Niko
dc.contributor.authorKOPECEK, Miloslav
dc.contributor.authorSVANCER, Patrik
dc.contributor.authorOLMOS, Ismael
dc.contributor.authorRICCIARDI, Carina
dc.contributor.authorIGLESIAS-GARCIA, Celso
dc.contributor.authorIGLESIAS-ALONSO, Ana
dc.contributor.authorSPINA, Edoardo
dc.contributor.authorRUAN, Can Jun
dc.contributor.authorWANG, Chuan Yue
dc.contributor.authorWANG, Gang
dc.contributor.authorTANG, Yi Lang
dc.contributor.authorLIN, Shih Ku
dc.contributor.authorLANE, Hsien Yuan
dc.contributor.authorKIM, Yong Sik
dc.contributor.authorKIM, Se Hyun
dc.contributor.authorRAJKUMAR, Anto P.
dc.contributor.authorGONZALEZ-ESQUIVEL, Dinora F.
dc.contributor.authorJUNG-COOK, Helgi
dc.contributor.authorBAPTISTA, Trino
dc.contributor.authorROHDE, Christopher
dc.contributor.authorNIELSEN, Jimmi
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorVERDOUX, Helene
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorQUILES, Clelia
dc.contributor.authorSANZ, Emilio J.
dc.contributor.authorLAS CUEVAS, Carlos De
dc.contributor.authorCOHEN, Dan
dc.contributor.authorSCHULTE, Peter F. J.
dc.contributor.authorERTUGRUL, Aygun
dc.contributor.authorYAGCIOGLU, A. Elif Anil
dc.contributor.authorCHOPRA, Nitin
dc.contributor.authorMCCOLLUM, Betsy
dc.contributor.authorSHELTON, Charles
dc.contributor.authorCOTES, Robert O.
dc.contributor.authorKAITHI, Arun R.
dc.contributor.authorKANE, John M.
dc.contributor.authorFAROOQ, Saeed
dc.contributor.authorNG, Chee H.
dc.contributor.authorBILBILY, John
dc.contributor.authorHIEMKE, Christoph
dc.contributor.authorLOPEZ-JARAMILLO, Carlos
dc.contributor.authorMCGRANE, Ian
dc.contributor.authorLANA, Fernando
dc.contributor.authorEAP, Chin B.
dc.contributor.authorARROJO-ROMERO, Manuel
dc.contributor.authorRADULESCU, Flavian S.
dc.contributor.authorSEIFRITZ, Erich
dc.contributor.authorEVERY-PALMER, Susanna
dc.contributor.authorBOUSMAN, Chad A.
dc.contributor.authorBEBAWI, Emmanuel
dc.contributor.authorBHATTACHARYA, Rahul
dc.contributor.authorKELLY, Deanna L.
dc.contributor.authorOTSUKA, Yuji
dc.contributor.authorLAZARY, Judit
dc.contributor.authorTORRES, Rafael
dc.contributor.authorYECORA, Agustin
dc.contributor.authorMOTUCA, Mariano
dc.contributor.authorCHAN, Sherry K. W.
dc.contributor.authorZOLEZZI, Monica
dc.contributor.authorOUANES, Sami
dc.contributor.authorBERARDIS, Domenico De
dc.contributor.authorGROVER, Sandeep
dc.contributor.authorPROCYSHYN, Ric M.
dc.contributor.authorADEBAYO, Richard A.
dc.contributor.authorKIRILOCHEV, Oleg O.
dc.contributor.authorSOLOVIEV, Andrey
dc.contributor.authorFOUNTOULAKIS, Konstantinos N.
dc.contributor.authorWILKOWSKA, Alina
dc.contributor.authorCUBALA, Wieslaw J.
dc.contributor.authorAYUB, Muhammad
dc.contributor.authorSILVA, Alzira
dc.contributor.authorBONELLI, Raphael M.
dc.contributor.authorVILLAGRAN-MORENO, Jose M.
dc.contributor.authorCRESPO-FACORRO, Benedicto
dc.contributor.authorTEMMINGH, Henk
dc.contributor.authorDECLOEDT, Eric
dc.contributor.authorPEDRO, Maria R.
dc.contributor.authorTAKEUCHI, Hiroyoshi
dc.contributor.authorTSUKAHARA, Masaru
dc.contributor.authorGRUNDER, Gerhard
dc.contributor.authorSAGUD, Marina
dc.contributor.authorCELOFIGA, Andreja
dc.contributor.authorRISTIC, Dragana Ignjatovic
dc.contributor.authorORTIZ, Bruno B.
dc.contributor.authorELKIS, Helio
dc.contributor.authorPACHECO PALHA, Antonio J.
dc.contributor.authorLLERENA, Adrian
dc.contributor.authorFERNANDEZ-EGEA, Emilio
dc.contributor.authorSISKIND, Dan
dc.contributor.authorWEIZMAN, Abraham
dc.contributor.authorMASMOUDI, Rim
dc.contributor.authorSAFFIAN, Shamin Mohd
dc.contributor.authorLEUNG, Jonathan G.
dc.contributor.authorBUCKLEY, Peter F.
dc.contributor.authorMARDER, Stephen R.
dc.contributor.authorCITROME, Leslie
dc.contributor.authorFREUDENREICH, Oliver
dc.contributor.authorCORRELL, Christoph U.
dc.contributor.authorMULLER, Daniel J.
dc.date.accessioned2022-01-18T14:16:23Z
dc.date.available2022-01-18T14:16:23Z
dc.date.issued2021-12-15
dc.identifier.issn1439-0795 (Electronic) 0176-3679 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/124424
dc.description.abstractEnThis 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.
dc.language.isoENen_US
dc.subject.enNative
dc.subject.enAmerican continental ancestry group
dc.subject.enAsian continental ancestry group
dc.subject.enClozapine/adverse effects
dc.subject.enClozapine/blood
dc.subject.enClozapine/metabolism
dc.subject.enClozapine/therapeutic use
dc.subject.enClozapine/toxicity
dc.subject.enCYP1A2
dc.subject.enDrug labeling
dc.subject.enEuropean continental ancestry group
dc.subject.enInfection
dc.subject.enInflammation
dc.subject.enMortality/drug effects
dc.subject.enSex
dc.subject.enSmoking.
dc.title.enAn International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels
dc.typeArticle de revueen_US
dc.identifier.doi10.1055/a-1625-6388en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed34911124en_US
bordeaux.journalPharmacopsychiatryen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamPharmacoEpi-Drugsen_US
bordeaux.teamAHEAD_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03532497
hal.version1
hal.date.transferred2022-01-18T14:16:31Z
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
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