https://scholars.lib.ntu.edu.tw/handle/123456789/199409
Title: | Switching From Clozapine to Zotepine in Patients With Schizophrenia A 12-Week Prospective, Randomized, Rater Blind, and Parallel Study | Authors: | Lin, Chao-Cheng Chiu, Hsien-Jane Chen, Jen-Yeu Liou, Ying-Jay Wang, Ying-Chieh Chen, Tzu-Ting Bai, Ya-Mei |
Keywords: | clozapine;zotepine;antipsychotics;schizophrenia;switch | Issue Date: | 2013 | Start page/Pages: | 211-214 | Source: | Journal of Clinical Psychopharmacology | Abstract: | Clozapine is the most effective antipsychotic for patients with treatment-refractory schizophrenia, but many adverse effects are noted. Clinicians usually hesitate to switch from clozapine to other antipsychotics because of the risk of a re-emergence or worsening of the psychosis, although empirical studies are very limited. Zotepine, an atypical antipsychotic with a pharmacologic profile similar to clozapine, was found to be an effective treatment for patients with treatment-resistant schizophrenia in Japan. This 12-week study is the first prospective, randomized, and rater-blind study to investigate the efficacy and tolerability of switching from clozapine to zotepine. Fifty-nine patients with schizophrenia, who had taken clozapine for at least 6 months with a Clinical Global Impression Severity score of at least 3, were randomly allocated to the zotepine and the clozapine groups. At the end of the study, 52 patients (88%) had completed the trial. The 7 withdrawal cases were all in the zotepine group. The final mean (SD) dose of zotepine and clozapine was 397.1 (75.7) versus 377.1 (62.5) mg/d, respectively. Patients in the zotepine group showed a significant increase in the Brief Psychiatric Rating Scale [mean (SD), 4.7 (8.7) vs -1.3 (6.3); P = 0.005], more general adverse effects as revealed by the Udvalg for Kliniske Undersogelser Rating Scale [mean (SD), 1.74 (3.9) vs -0.2 (2.8); P = 0.039], more extrapyramidal adverse effects as demonstrated by the Simpson and Angus Scale [mean (SD), 1.29 (3.5) vs 0.17 (2.1); P = 0.022], an increased use of propranolol (37.1% vs 0%, P < 0.0001) and anticholinergics (25.7% vs 0%, P = 0.008), and an increased level of prolactin (29.6 vs -3.8 ng/ mL, P < 0.0005), compared with the clozapine group. The results suggested that switching from clozapine to zotepine treatment should be done with caution. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/260334 | DOI: | 10.1097/JCP.0b013e31828700c7 | SDG/Keyword: | cholinergic receptor blocking agent; clozapine; prolactin; propranolol; zotepine; adult; aged; article; Brief Psychiatric Rating Scale; Clinical Global Impression scale; controlled study; drug efficacy; drug substitution; drug tolerability; drug withdrawal; human; Kliniske Undersogelser Rating Scale; major clinical study; priority journal; prospective study; randomized controlled trial; rating scale; schizophrenia; Simpson-Angus Scale; treatment duration; Adult; Aged; Antipsychotic Agents; Clozapine; Dibenzothiepins; Dose-Response Relationship, Drug; Drug Substitution; Humans; Middle Aged; Prospective Studies; Psychiatric Status Rating Scales; Schizophrenia; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Young Adult |
Appears in Collections: | 醫學系 |
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