Optimizing clozapine treatment

摘要: Nielsen J, Damkier P, Lublin H, Taylor D. Optimizing clozapine treatment. Objective:  Clozapine treatment remains the gold standard for treatment-resistant schizophrenia, but with is associated several side-effects that complicate use of drug. This clinical overview aims to provide psychiatrists knowledge about how optimize treatment. Relevant strategies reducing and increasing likelihood response are discussed. Method:  Studies available in MEDLINE were reviewed. Results:  A slow up-titration recommended order reach optimal dosage diminish risk dose-dependent side-effects. Particularly, case partial or non-response, therapeutic drug monitoring recommended. Plasma levels above threshold 350–420 ng/ml necessary determine non-response clozapine. To ease burden side-effects, dose reduction should be tried combination another antipsychotic may facilitate further reduction. For most counteracting medication exists. Augmentation lamotrigine, antipsychotics, electroconvulsive therapy beneficial clozapine. Conclusion:  Treatment optimized increase rate minimize thus diminishing discontinuation psychotic relapse.