Guía internacional para una dosificación más segura de la clozapina en adultos mediante el uso de 6 titulaciones personalizadas de dosis basados en la etnicidad, la proteína C reactiva y los niveles de clozapina

  1. Jose de Leon 1
  2. Georgios Schoretsanitis 2
  3. RobertL. Smith 3
  4. Espen Molden 3
  5. Anssi Solismaa 4
  6. Niko Seppälä 5
  7. Miloslav Kopeček 6
  8. Patrik Švancer 6
  9. Ismael Olmos 7
  10. Carina Ricciardi 7
  11. Celso Iglesias-Garcia 8
  12. Ana Iglesias-Alonso 9
  13. Edoardo Spina 10
  14. Can-Jun Ruan 11
  15. Chuan-Yue Wang 11
  16. Gang Wang 11
  17. Yi-Lang Tang 12
  18. Shih-Ku Lin 13
  19. Hsien-Yuan Lane
  20. Yong-Sik Kim
  21. Se Hyun Kim
  22. Anto P. Rajkumar
  23. Dinora F. González Esquivel
  24. Helgi Jung Cook
  25. Trino Baptista
  26. Christopher Rohde
  27. Jimmi Nielsen
  28. Hélène Verdoux
  29. Clelia Quile
  30. Emilio J. Sanz
  31. Carlos de las Cuevas Castresana
  32. Dan Cohen 14
  33. Peter F.J. Schult 15
  34. Aygün Ertuğrul
  35. A. Elif Anıl Yağcıoğlu
  36. Nitin Chopra
  37. Betsy McCollum 1
  38. Charles Shelton 1
  39. Robert O. Cotes 16
  40. Arun R. Kaithi
  41. John M. Kane 17
  42. Saeed Farooq
  43. Chee H. Ng 18
  44. John Bilbily 19
  45. Christoph Hiemke
  46. Carlos López Jaramillo 20
  47. Ian McGrane
  48. Fernando Lana 21
  49. Chin B. Eap 22
  50. Manuel Arrojo Romero
  51. Flavian Ştefan Rădulescu 23
  52. Erich Seifritz
  53. Susanna Every Palmer
  54. Chad A. Bousman 24
  55. Emmanuel Bebawi 25
  56. Rahul Bhattacharya
  57. Deanna L. Kelly
  58. Yuji Otsuka 26
  59. Judit Lazary 27
  60. Rafael Torres 28
  61. Agustin Yecora 29
  62. Mariano Motuca 30
  63. Sherry Kit Wa Chan 31
  64. Monica Zolezzi 32
  65. Sami Ouanes 33
  66. Domenico De Berardis 34
  67. Sandeep Grover
  68. Ric M. Procyshyn
  69. Richard A. Adebayo 35
  70. Oleg O. Kirilochev
  71. Andrey Soloviev 36
  72. Konstantinos N. Fountoulakis
  73. Alina Wilkowska 37
  74. Wiesław-Jerzy Cubała
  75. Muhammad Ayub 38
  76. Alzira Silva 39
  77. Raphael M. Bonelli 40
  78. José María Villagrán Moreno
  79. Benedicto Crespo Facorro
  80. Henk Temmingh 41
  81. Eric Decloedt 42
  82. Maria Rosel Pedro 43
  83. Hiroyoshi Takeuchi
  84. Masaru Tsukahara
  85. Gerhard Gründer
  86. Marina Sagud 44
  87. Andreja Celofiga
  88. Dragana Ignjatović Ristić
  89. Bruno Bertolucci Orti
  90. Helio Elkis
  91. José Antonio Pacheco Palha 45
  92. Adrián Llerena Ruiz
  93. Emilio Fernández-Egea
  94. Dan Siskind
  95. Abraham Weizman
  96. Rim Masmoudi 46
  97. Shamin Mohd Saffian 47
  98. Jonathan G. Leung 48
  99. Peter F. Buckley
  100. Stephen R. Marder 49
  101. Leslie L. Citrome
  102. Oliver Freudenreich
  103. Christoph U. Correll
  104. Daniel J. Müller
  105. Show all authors +
  1. 1 Hospital Eastern State, Lexington, Kentucky, Estados Unidos
  2. 2 Hospital Psiquiátrico, Universidad de Zürich
  3. 3 Hospital Diakonhjemmet, Oslo
  4. 4 Universidad Tampere, Finlandia
  5. 5 Departamento de Psiquiatría, Satasairaala, Finlandia
  6. 6 Instituto Nacional de Salud Mental, Klecany, República Checa
  7. 7 Hospital Vilardebó, Administración de Servicios de Salud, Montevideo, Uruguay
  8. 8 CIBERSAM, INEUROPA, ISPA-FIMBA, Universidad de Oviedo
  9. 9 Hospital Universitario Central de Asturias, Oviedo
  10. 10 University of Messina
    info

    University of Messina

    Mesina, Italia

    ROR https://ror.org/05ctdxz19

  11. 11 Hospital Beijing Anding, Universidad Capital Medical, Beijing
  12. 12 Universidad de Emory, Atlanta
  13. 13 Hospital Linkou Chang Gung Memorial, Taoyuan, Taiwan
  14. 14 Servicios de Salud Mental North-Holland North, Países Bajos
  15. 15 Servicios de Salud Mental Noord-Holland-Noord, Alkmaar, Países Bajos
  16. 16 Centro Médico Atlanta VA, Decatur, Georgia, Estados Unidos
  17. 17 Hospital Zucker Hillside, Investigación Psiquiátrica, Northwell Health, Glen Oaks, New York, Estados Unidos
  18. 18 The University of Melbourne, Melbourne, Victoria, Australia
  19. 19 Universidad Washington en St. Louis, St. Louis, Missouri, Estados Unidos
  20. 20 Universidad de Antioquia, Medellin, Colombia
  21. 21 Universitat Autònoma de Barcelona
    info

    Universitat Autònoma de Barcelona

    Barcelona, España

    ROR https://ror.org/052g8jq94

  22. 22 Hospital Universitario y Universidad de Lausanne, Suiza
  23. 23 Universidad de Medicina y Farmacia Carol Davila, Bucharest, Rumania
  24. 24 Universidad de Calgary, Alberta, Canadá
  25. 25 Universidad de Montreal
  26. 26 Departamento de Psiquiatría, Hospital General Asahi, Chiba, Japón
  27. 27 Instituto Nacional de Salud Mental, Budapest, Hungría
  28. 28 Pontificia Universidad Católica de Chile
    info

    Pontificia Universidad Católica de Chile

    Santiago de Chile, Chile

    ROR https://ror.org/04teye511

  29. 29 Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy, Argentina
  30. 30 Universidad Washington en St. Louis
  31. 31 Universidad de Hong Kong, China
  32. 32 Universidad de Qatar
  33. 33 Corporación Médica Hamad, Doha, Qatar
  34. 34 Hospital “G. Mazzini”, Teramo, Italia
  35. 35 Hospital Neuropsiquiátrico Federal de Yaba, Lagos, Nigeria
  36. 36 Universidad Médica Estatal del Norte, Arkhangelsk, Rusia
  37. 37 Universidad Médica de Gdańsk, Gdańsk, Polonia
  38. 38 Universidad de Queens, Kingston, Canadá
  39. 39 Universidad de Porto, Porto, Portugal
  40. 40 Universidad Sigmund Freud, Vienna, Austria
  41. 41 Universidad de Cape Town, Hospital Valkenberg, Western Cape, Cape Town, Sudáfrica
  42. 42 Universidad de Stellenbosch, Cape Town, Sudáfrica
  43. 43 Hospital Central de Maputo, Maputo, Mozambique
  44. 44 Universidad de Zagreb, Zagreb, Croacia
  45. 45 Facultad de Medicina de Oporto, Oporto, Portugal
  46. 46 Universidad de Sfax, Sfax, Túnez
  47. 47 Universidad de Kebangsaan Malaysia, Kuala Lumpur, Malasia
  48. 48 Mayo Clinic, Rochester, Minnesota, Estados Unidos
  49. 49 Universidad de California, Los Angeles, California, Estados Unidos
Show affiliations +
Journal:
Psiquiatría biológica: Publicación oficial de la Sociedad Española de Psiquiatría Biológica

ISSN: 1134-5934

Year of publication: 2023

Volume: 30

Issue: 3

Type: Article

DIALNET GOOGLE SCHOLAR

More publications in: Psiquiatría biológica: Publicación oficial de la Sociedad Española de Psiquiatría Biológica

Abstract

This is the Spanish translation of an international guideline which proposes improving clozapine package inserts worldwide by using ancestry-based: 1) dosing and 2) titration. Adverse drug reaction (ADR) databases suggest clozapine: 1) is the third most toxic drug in the United States (US), and 2) produces worldwide pneumonia mortality four times greater than that of 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 require the lowest dose and male smokers the highest dose). Poor metabolizer (PM) 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. People with ancestry from Asia (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/ml. Daily doses of 300-600 mg/day are recommended in the US. Slow personalized titration may prevent early ADRs (including syncope, myocarditis and pneumonia). The core of this guideline consists of six personalized titration schedules for inpatients: 1) Asian/Amerindian ancestry with lower metabolism (in cases of obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) Asian/Amerindian ancestry with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (in cases of 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 of non-Asian/Amerindian ancestry with lower clozapine metabolism (in cases of obesity or valproate) needing 150-300 mg/day, and 6) in the US of non-Asian/Amerindian ancestry with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least 4 weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.

Data source: Dialnet