MyMedR

Mohd Fadzli, M.I., Nazariah, H., Aili, H.H.

Malaysian Journal of Psychiatry, 2012;21(1):0-0.

MyJurnal

Clozapine is an effective anti-psychotic and has long been used as an intervention for treatment-resistant schizophrenia. This case report will highlight the use of Clozapine up to 100 mg ON as a second-line medication to achieve satisfactory response after 5 weeks in an adolescent who was recently diagnosed with schizophrenia.

Matched MeSH terms: Clozapine

Fulltext Polypharmacy, An Option Prior To Clozapine?: A Case Report

Amer Siddiq, A.N.

Medicine & Health, 2008;3(2):318-321.

MyJurnal

This is a report of a patient on multiple antipsychotic medications for the treatment of schizophrenia. Often, polypharmacy is not encouraged, however, with the advent of newer atypical antipsychotic agents, this practice may need review. This case will be used to highlight the rare instances when polypharmacy may be useful prior to the commencement of clozapine for the treatment of schizophrenia.

Matched MeSH terms: Clozapine

Fulltext Haloperidol in treatment resistant schizophrenia: a case report

Ridzwan, H., Saifuddin, T.M.

Malaysian Journal of Psychiatry, 2017;26(2):0-0.

MyJurnal

A substantial percentage of patients will have an inadequate response to
clozapine in treatment resistance schizophrenia. Therefore, different
approaches need to be considered for managing this group of patients. We
present a case of a treatment resistant schizophrenia patient who shows poor
response toward clozapine. Later, he was started with haloperidol. Even
though antipsychotic superiority of clozapine in relation to haloperidol is
significant, this patient demonstrated otherwise.

Matched MeSH terms: Clozapine

Fulltext Clozapine induced priapism: case series

Thangam, N., Farah Radhiah, H., Sashitharan, D., Abdul Kadir, A.K.

Malaysian Journal of Psychiatry, 2016;25(2):0-0.

MyJurnal

Clozapine is effective in treatment resistant schizophrenia. Priaprism is a rare side effect of Clozapine. It is a urological emergency and can lead to permanent damage to the penis. We present two cases two cases of clozapine induced priapism. Both patients were started on Clozapine in view of treatment resistant. For the first patient, priapism was noted after 2 years on Clozapine and treated conservatively. Clozapine was rechallenged in this patient but in a lower dosage and was augmented with amisulpride. He did not develop priaprism until date. In the second case, patient developed priaprism after 7 months on clozapine and required urological intervention. He redeveloped recurrent episode of priaprism as clozapine was restarted on the previous dose. In conclusion, priaprism is not related to dosage or duration of treatment of Clozapine. Thus, a careful risk-benefit assessment need to done as there is always a risk of priapism to recur when clozapine rechallenged.

Matched MeSH terms: Clozapine

Fulltext Clozapine re-challenge with lithium supplementation following clozapine-induced neutropenia

Ahmad Nabil Md Rosli, Subbiah, Rakesh, Maniam, T.

ASEAN Journal of Psychiatry, 2014;15(1):90-92.

MyJurnal

Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatment- resistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 90-92.

Matched MeSH terms: Clozapine

Fulltext Clozapine-induced constipation: a case report

Teh, Y.W., Teh, E.E., Russell, V.

Malaysian Journal of Psychiatry, 2014;23(1):77-80.

MyJurnal

Clozapine is an atypical antipsychotic medication, used primarily as the drug of choice in treatment resistant schizophrenia. Despite its considerable advantages, clozapine’s licence is restricted because of its potential to induce agranulocytosis. Hence, white blood cell count monitoring is mandatory in patients receiving clozapine treatment. A side effect of clozapine that has received relatively less attention is constipation, which is caused by the drug’s anticholinergic effect. This potentially serious problem can result in life- threatening bowel obstruction, ischemia, necrosis, perforation, and pulmonary aspiration. Despite this evidence, routine inquiry about constipation in clozapine treated patients is not emphasised in current clinical guidance. We report a case to highlight constipation as both a potentially serious side effect and as a factor, insufficiently recognised, in non-adherence to clozapine.

Matched MeSH terms: Clozapine

Fulltext Clozapine and Polycythemia Rubra Vera: a rare side effect or a separate medical condition? – a case report

Tan, H.P.J.

Malaysian Journal of Psychiatry, 2016;25(2):0-0.

MyJurnal

This article highlights the case of a 44-year old Malay man who is diagnosed as having treatment resistant schizophrenia on Clozapine, which then developed Polycythemia Rubra Vera (PRV). It is known that a major side effect for Clozapine is of agranulocytosis, that is a potentially fatal side effect. However, there have been reported disturbances of other hematological parameters, which result in other abnormalities including leucopenia, leucocytosis, thrombocytopenia, thrombocytosis and eosinophilia. Could this case be a pure medical condition of PRV or is there a relation to the effects of Clozapine? In this paper, the aim is to report a case of blood dyscrasia in a 44-year old male who developed Polycythemia Rubra Vera a year after he was observed to have abnormal full blood count results.

Matched MeSH terms: Clozapine

Capgras syndrome in a very late onset, treatment resistant schizophrenia

Ain MK, Rosdinom R, Raynuha M

Int Psychogeriatr, 2015 Sep;27(9):1573-5.

PMID: 25794136 DOI: 10.1017/S1041610215000332

We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.

Matched MeSH terms: Clozapine/therapeutic use*

Fulltext Agranulocytosis monitoring with Clozapine patients: to follow guidelines or to attempt therapeutic controversies?

Chandrasekaran PK

Singapore Med J, 2008 Feb;49(2):96-9.

PMID: 18301833

Clozapine is an atypical antipsychotic with superior efficacy in the treatment of refractory schizophrenia. But it can cause agranulocytosis, which occurs in one to two percent of patients. This paper was prepared to discuss the condoned and controversial issues of therapy with this drug, but only within a haematological context. The feasibility of attempting therapeutically controversial blood monitoring regimes, as opposed to following standardised Western guidelines, given the differences in terms of accessibility, convenience and financial considerations between the public and private sector medical care will also be discussed. The proposal of adopting a structured pro forma, with a risk-benefit assessment, in the event of unavoidable veering from the guidelines may allay medicolegal implications, especially in countries where blood monitoring is not mandatory. It is hoped that this article will stimulate further research in our region, bearing in mind the increasing awareness and focus on genetic polymorphism, and the possibility of drawing up our own monitoring guidelines in the near future.

Matched MeSH terms: Clozapine/adverse effects*

Fulltext Clozapine-induced fatal bowel ischaemia - a neglected side effect?

Razak, N.A., Mohd Nor, F., Shafie, M.S., Hwang, I.S.

Malaysian Journal of Psychiatry, 2017;26(1):0-0.

MyJurnal

There have been previous reported deaths due to clozapine-induced
constipation. In all these cases, patients have experienced prior abdominal
symptoms over a period of weeks or months. Clozapine is an anti-psychotic
drug, and it is widely used for treatment of schizophrenia. The important
side-effects of clozapine include postural hypotension, weight gain,
tachycardia, cardiomyopathy, cardiomyositis, seizures, hypersalivation and
agranulocytosis. However, constipation induced by clozapine need to be
addressed since it may cause fatal consequences. Constipation associated with
clozapine is thought to be mediated by the drugs' pronounced dosedependent
cholinergic and serotonergic antagonism. Hence, a clozapineinduced
rapidly fatal bowel ischaemia is the highlight of this report and this
risky side-effect should be aware by the psychiatrist or physician before
commencing the treatment.

Matched MeSH terms: Clozapine

Fulltext Allergic cutaneous and visceral angioedema secondary to clozapine: a case report

Chia, L.C., Ahmad Nabil, M.R., Marhani, M., Muna Hamiza, A.

Medicine & Health, 2017;12(1):122-126.

MyJurnal

This report stresses on the occurrence of a rare adverse reaction to clozapine, i.e. allergic cutaneous and visceral angioedema, in a patient with treatment resistant schizophrenia (TRS). We report the case of a schizophrenic patient who was resistant to treatment and developed an allergic reaction involving her skin and gastro-intestinal system upon the commencement of clozapine. She was then treated with a combination pharmacotherapy which left some residual symptoms. The manifestation of allergic reactions to clozapine and its management strategies are discussed in the paper. There is a pressing need to develop a new psychotropic which is on par with clozapine.
Keywords: allergy, angioedema, clozapine, schizophrenia

Matched MeSH terms: Clozapine

Fulltext Unfitness to plead among female offenders: when looseness matters

Loo, Jiann Lin, Eu, Choon Leng, Johari Khamis, Raba'iah Mohd Salleh, Suarn Singh Jasmit Singh

ASEAN Journal of Psychiatry, 2018;19(1):0-0.

MyJurnal

Objective: Pritchard Criteria are adopted in a Malaysian criminal-justice system while assessing fitness to plead. There is limited data on the reason of unfitness to plead for female offenders in Malaysia.

Methods: A case series of five patients hospitalized to Hospital Bahagia Ulu Kinta, Malaysia due to unfitness to plead was presented and discussed.

Result: The offences include three homicides, one assault, and one stealing. All of them were diagnosed to have schizophrenia with prominent looseness of association. Four of them subsequently treated as Treatment-Resistant Schizophrenia (TRS) with a minimal response toward clozapine.

Conclusion: Looseness of association may be a contributing factor for unfitness to plead among Malaysian female offenders, which can result in indeterminate hospitalization. This should be confirmed in a larger prospective study.

Matched MeSH terms: Clozapine

A Bibliometric Analysis of Scientific Production on Second-Generation Anti-Psychotic Drugs in Malaysia

López-Muñoz F, Povedano-Montero FJ, Chee KY, Shen WW, Fernández-Martín P, García-Pacios J, et al.

Malays J Med Sci, 2018 May;25(3):40-55.

PMID: 30899186 DOI: 10.21315/mjms2018.25.3.5

Objective: We carried out a bibliometric study on the scientific papers related to second-generation antipsychotic drugs (SGAs) in Malaysia.

Methods: With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price's law and Bradford's law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D).

Results: We found 105 original documents published between 2004 and 2016. Our results fulfilled Price's law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3.

Conclusion: The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.

Matched MeSH terms: Clozapine

Fulltext Directly observed therapy for clozapine with concomitant methadone prescription: a method for improving adherence and outcome

Pang NTP, Mohamad Isa MF, Suarn Singh V, Masiran R

BMJ Case Rep, 2017 Jul 27;2017.

PMID: 28754761 DOI: 10.1136/bcr-2017-221048

A young male presented with many years of delusions and hallucinations, with concurrent heroin use and subsequent amphetamine uses. There were no depressive or manic symptoms and psychotic symptoms prior to the amphetamine use. After the trials of two atypical antipsychotics and later clozapine due to treatment resistance, adherence and functionality were poor and there was still persistent drug use. As a result, a long acting injectable adjunct was commenced, but only minimal effects were observed. However after initiation of directly observed treatment of clozapine with methadone, there has been functional and clinical response and drug use has ceased.

Matched MeSH terms: Clozapine/therapeutic use*

Metabolic syndrome and antipsychotic monotherapy treatment among schizophrenia patients in Malaysia

Said MA, Hatim A, Habil MH, Zafidah W, Haslina MY, Badiah Y, et al.

Prev Med, 2013;57 Suppl:S50-3.

PMID: 23337566 DOI: 10.1016/j.ypmed.2013.01.005

OBJECTIVE: The objective of this study is to determine the prevalence of metabolic syndrome among schizophrenia patients receiving antipsychotic monotherapy in Malaysia.
METHOD: A cross-sectional study was conducted at multiple centres between June 2008 and September 2011. Two hundred and five patients who fulfilled the DSM IV-TR diagnostic criteria for schizophrenia and who had been on antipsychotic medication for at least one year, were screened for metabolic syndrome. Patients receiving a mood stabilizer were excluded from the study. Metabolic syndrome was defined by using the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Treatment Panel III (ATP III) modified for Asian waist circumference.
RESULTS: In the first-generation antipsychotic (FGA) group, the highest prevalence of metabolic syndrome was among patients treated with trifluoperazine and flupenthixol decanoate (66.7% each). For the second-generation antipsychotic (SGA) group, the highest prevalence of metabolic syndrome was among patients treated with clozapine (66.7%). The component with the highest prevalence in metabolic syndrome was waist circumference in both FGA and SGA groups except for aripiprazole in SGA.
CONCLUSION: The prevalence of metabolic syndrome in schizophrenia patients receiving antipsychotic monotherapy in Malaysia was very high. Intervention measures are urgently needed to combat these problems.
KEYWORDS: Antipsychotics; Metabolic syndrome; Monotherapy; Prevalence; Schizophrenia

Matched MeSH terms: Clozapine/adverse effects; Clozapine/therapeutic use

Fulltext Prevalence of obesity, lipid and glucose abnormalities in outpatients prescribed clozapine in University Malaya Medical Center, Kuala Lumpur

Sharmilla, T., Ahmad, H.S., Jambunathan, S.T.

Malaysian Journal of Psychiatry, 2008;17(2):1-10.

MyJurnal

Objective: The objectives of this study were to asses body mass index, fasting blood sugar , serum cholesterol levels and prevalence of Diabetes Mellitus among outpatients attending the Clozapine clinic at University Malaya Medical Center. Method: 36 patients had their height and weight taken at the start of the study. Their BMI (body mass index) was calculated. Fasting blood sugar, (FBS) and Fasting Serum Lipid (FSL) were performed. Result: The mean body mass index was 24.63. The prevalence of obesity was 13.89%. The prevalence of overweight was 27.8 % and the prevalence of underweight was 5.55%. The prevalence of Diabetes Mellitus was 2.78 %. Serum triglyceride levels appear to be elevated in those receiving Clozapine.Conclusion: It appears that Clozapine may predispose one to obesity. From our study we cannot conclude if Clozapine causes Diabetes Mellitus. However treatment with Clozapine may be associated with elevated levels of serum triglycerides.

Study site: Clozapine clinic at University Malaya Medical Center

Matched MeSH terms: Clozapine

Fulltext Co-morbid hypertension, diabetes mellitus or dyslipidemia among patients prescribed with second generation antipsychotic: a comparison study between aripiprazole, quetiapine and clozapine based on pharmacy prescription database

Ng CG, Chan PL, Said MA

Malaysian Journal of Psychiatry, 2015;24(2):0-0.

MyJurnal

Introduction: Second generation antipsychotic (SGA) was linked to increased risk of metabolic syndrome. The risk varies between different SGA. We aim to study this risk by examining the co-prescription of antihypertensive, antidiabetic and lipid lowering drugs in patients prescribed with either aripiprazole, quetiapine or clozapine.
Methods: This is a retrospective cohort study based on the prescription records of a teaching hospital. Prescription records between January 1, 2013 and December 31, 2014 for
psychiatric unit were extracted. Patients with at least one prescription of any antipsychotic were included. The odds of antihypertensive, antidiabetic and lipid lowering drugs co-prescription in patients with either aripiprazole, quetiapine or clozapine were calculated.
Results: Of the 1742 study subjects, 88 patients were prescribed with aripiprazole, 175 patients with clozapine and 124 patients with quetiapine. Patients prescribed with quetiapine had
higher odds of co-prescribed with antihypertensive (OR = 1.71, 95% CI = 1.11, 2.63), antidiabetic drugs (OR = 1.81, 95% CI = 1.11, 2.95) and lipid lowering drugs (OR = 1.94, 95% CI = 1.19, 3.16). There were higher odds of co-prescription of antihypertensive (OR = 1.54, 95% CI = 1.05, 2.25), antidiabetic drugs (OR = 1.69, 95% CI = 1.10, 2.59) and lipid lowering drugs
(OR = 1.90, 95% CI = 1.24, 2.91) in patients with clozapine. However, there were no increase odds of co-prescription of the three agents in patients with aripiprazole.
Conclusion: We need to monitor the risk of metabolic syndrome in patients treated with SGA. Aripiprazole has lower risk of metabolic syndrome.

Matched MeSH terms: Clozapine

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