Clozapine: new preparation. A last resort for parkinsonian patients with psychosis.
Identifieur interne : 000244 ( Ncbi/Merge ); précédent : 000243; suivant : 000245Clozapine: new preparation. A last resort for parkinsonian patients with psychosis.
Auteurs :Source :
- Prescrire international [ 1167-7422 ] ; 2002.
Descripteurs français
- Wicri :
- geographic : France.
English descriptors
- KwdEn :
- Antiparkinson Agents (adverse effects), Antiparkinson Agents (therapeutic use), Antipsychotic Agents (administration & dosage), Antipsychotic Agents (adverse effects), Antipsychotic Agents (therapeutic use), Clinical Trials as Topic, Clozapine (administration & dosage), Clozapine (adverse effects), Clozapine (therapeutic use), Dopamine Agents (adverse effects), Dopamine Agents (therapeutic use), Drug Approval, France, Humans, Parkinson Disease (complications), Parkinson Disease (drug therapy), Psychoses, Substance-Induced (drug therapy), Treatment Outcome.
- MESH :
- chemical , administration & dosage : Antipsychotic Agents, Clozapine.
- chemical , adverse effects : Antiparkinson Agents, Antipsychotic Agents, Clozapine, Dopamine Agents.
- chemical , therapeutic use : Antiparkinson Agents, Antipsychotic Agents, Clozapine, Dopamine Agents.
- geographic : France.
- complications : Parkinson Disease.
- drug therapy : Parkinson Disease, Psychoses, Substance-Induced.
- Clinical Trials as Topic, Drug Approval, Humans, Treatment Outcome.
Abstract
(1) Psychotic disorders occurring in patients with Parkinson's disease are usually linked to antiparkinsonian treatments. Tapering the dose of dopaminergic or anticholinergic drugs does not always yield a satisfactory balance between the psychotic and motor disorders. Most neuroleptics tend to worsen extrapyramidal manifestations and are contraindicated in combination with dopaminergic agents. Their assessment in patients with Parkinson's disease has been limited. (2) Clozapine, a neuroleptic, is now indicated in this type of patient. (3) The evidence comes from two double-blind placebo-controlled trials, each involving 60 patients. In these trials, 40% of patients lost all their psychotic disorders on low-dose clozapine, usually with no worsening of parkinsonian manifestations. (4) In clinical trials of clozapine in Parkinson's disease, the incidence of neutropenia was between 2 and 3%, and that of agranulocytosis 0.3%. The risks of myocarditis, dilated myocardiopathy and malignant neuroleptic syndrome associated with clozapine call for strict pharmacovigilance. (5) In practice, when adjusting antiparkinsonian treatment fails to strike a balance between psychotic and parkinsonism disorders, clozapine is the standard neuroleptic. It should be used with care, however, because of its adverse effects.
PubMed: 11985366
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Tapering the dose of dopaminergic or anticholinergic drugs does not always yield a satisfactory balance between the psychotic and motor disorders. Most neuroleptics tend to worsen extrapyramidal manifestations and are contraindicated in combination with dopaminergic agents. Their assessment in patients with Parkinson's disease has been limited. (2) Clozapine, a neuroleptic, is now indicated in this type of patient. (3) The evidence comes from two double-blind placebo-controlled trials, each involving 60 patients. In these trials, 40% of patients lost all their psychotic disorders on low-dose clozapine, usually with no worsening of parkinsonian manifestations. (4) In clinical trials of clozapine in Parkinson's disease, the incidence of neutropenia was between 2 and 3%, and that of agranulocytosis 0.3%. The risks of myocarditis, dilated myocardiopathy and malignant neuroleptic syndrome associated with clozapine call for strict pharmacovigilance. (5) In practice, when adjusting antiparkinsonian treatment fails to strike a balance between psychotic and parkinsonism disorders, clozapine is the standard neuroleptic. It should be used with care, however, because of its adverse effects.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="HSR"><PMID Version="1">11985366</PMID><DateCreated><Year>2002</Year><Month>05</Month><Day>01</Day></DateCreated><DateCompleted><Year>2002</Year><Month>05</Month><Day>09</Day></DateCompleted><DateRevised><Year>2013</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1167-7422</ISSN><JournalIssue CitedMedium="Print"><Volume>11</Volume><Issue>57</Issue><PubDate><Year>2002</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Prescrire international</Title><ISOAbbreviation>Prescrire Int</ISOAbbreviation></Journal><ArticleTitle>Clozapine: new preparation. 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(4) In clinical trials of clozapine in Parkinson's disease, the incidence of neutropenia was between 2 and 3%, and that of agranulocytosis 0.3%. The risks of myocarditis, dilated myocardiopathy and malignant neuroleptic syndrome associated with clozapine call for strict pharmacovigilance. (5) In practice, when adjusting antiparkinsonian treatment fails to strike a balance between psychotic and parkinsonism disorders, clozapine is the standard neuroleptic. 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