White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing ...White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing myocarditis or pneumonia during clozapine titrations.Prescribers worldwide are largely unaware of that.Meanwhile,as they worry about agranulocytosis,their clozapine-treated patients are at risk of dying from pneumonia or myocarditis.Consequently,an international guideline with 104 authors from 50 countries/regions was recently published to provide personalised clozapine titration schedules for adult inpatients.This forum article reviews pneumonia and myocarditis occurring during clozapine titration,as well as the three most innovative aspects of this new guideline:(1)personalised titration,(2)C reactive protein(CRP)measures,and(3)dose predictions based on blood levels.Clozapine metabolism is influenced by 3 levels of complexity:(1)ancestry groups,(2)sex-smoking subgroups,and(3)presence/absence of poor metabolizer status.These 3 groups of variables should determine the maintenance dose and speed of clozapine titration;they are summarised in a table in the full-text.The international clozapine titration guideline recommends measuring CRP levels simultaneously with WBC,at baseline and weekly at least for the first 4 weeks of titration,the highest risk period for clozapine-induced myocarditis.展开更多
基金Acknowledgements Lorraine Maw at the Mental Health Research Center at Eastern State Hospital,Lexington,Kentucky,USA helped with editing.Ms.Maw declares no competing interest in the last 36 months.
文摘White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing myocarditis or pneumonia during clozapine titrations.Prescribers worldwide are largely unaware of that.Meanwhile,as they worry about agranulocytosis,their clozapine-treated patients are at risk of dying from pneumonia or myocarditis.Consequently,an international guideline with 104 authors from 50 countries/regions was recently published to provide personalised clozapine titration schedules for adult inpatients.This forum article reviews pneumonia and myocarditis occurring during clozapine titration,as well as the three most innovative aspects of this new guideline:(1)personalised titration,(2)C reactive protein(CRP)measures,and(3)dose predictions based on blood levels.Clozapine metabolism is influenced by 3 levels of complexity:(1)ancestry groups,(2)sex-smoking subgroups,and(3)presence/absence of poor metabolizer status.These 3 groups of variables should determine the maintenance dose and speed of clozapine titration;they are summarised in a table in the full-text.The international clozapine titration guideline recommends measuring CRP levels simultaneously with WBC,at baseline and weekly at least for the first 4 weeks of titration,the highest risk period for clozapine-induced myocarditis.
