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Clozapine/norclozapine plasma concentrations and their ratio in treatment resistant, early psychosis patients.
Psychiatriki
April 2025
Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
Treatment-resistant schizophrenia affects approximately 30% of schizophrenia patients, and clozapine is the antipsychotic of choice for their treatment. Despite its effectiveness, clozapine is considerably under-prescribed for the aforementioned patients' group, probably due to its severe side effects. Measurement of plasma concentrations of clozapine and its active metabolite, norclozapine, in plasma could help clinicians to monitor compliance to treatment and reduce the possibility of severe side effects.
View Article and Find Full Text PDFClozapine/norclozapine plasma level ratio and cognitive functioning in patients with schizophrenia spectrum disorders: a systematic review.
Ther Adv Psychopharmacol
December 2024
Department of Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands.
Article Synopsis
- Limited research exists on cognitive functioning in treatment-resistant schizophrenia (TRS), and current findings on clozapine's effect on cognition are inconsistent, with a particular lack of studies on the CLO/NCLO ratio.
- A systematic review identified 15 studies involving clozapine users, assessing their cognitive abilities through various tests and composite scores, with 11 studies deemed of fair quality.
- A negative relationship was discovered between the CLO/NCLO ratio and certain cognitive abilities like attention and social cognition, while no significant correlations were found for other cognitive domains such as processing speed or working memory.
Plasma Clozapine and N -Desmethylclozapine (Norclozapine) Concentrations and the Clozapine/Norclozapine Ratio : Effect of Dose, Sex, and Cigarette Smoking.
J Clin Psychopharmacol
September 2024
Department of Psychological Medicine, University of Otago, Wellington, Wellington, New Zealand.
Background: Smoking enhances plasma clozapine clearance, but the magnitude of the effect across the dose and age ranges is unclear.
Methods: We audited clozapine dose and predose plasma clozapine and N -desmethylclozapine (norclozapine) concentrations by sex and smoking habit in samples submitted for clozapine TDM, 1996-2017.
Results: There were 105,316/60,792 and 34,288/31,309 samples from male/female smokers/nonsmokers, respectively.
Clozapine: Dose, Sex, Ethnicity, Smoking Habit, Age, Body Weight, and Plasma Clozapine and N -Desmethylclozapine (Norclozapine) Concentrations in Clinical Practice.
J Clin Psychopharmacol
March 2023
Division of Psychiatry, University College London, London, United Kingdom.
Background: Guidance on clozapine dosing in treatment refractory schizophrenia is based largely on data from young adult male White patients.
Aim: This study aimed to audit the plasma clozapine and N -desmethylclozapine (norclozapine) concentrations attained in male and female patients of different ethnicity and smoking habit.
Method: The effect of dose, sex, ethnicity, age, body weight, and smoking habit on plasma clozapine and norclozapine concentrations were studied using data from a therapeutic drug monitoring service, 1993 to 2017.
Influence of dose, cigarette smoking, age, sex, and metabolic activity on plasma clozapine concentrations: a predictive model and nomograms to aid clozapine dose adjustment and to assess compliance in individual patients.
J Clin Psychopharmacol
February 2004
Molecular Pharmacology and Pharmacogenetics, The University of Sheffield, Sheffield, UK.
The measurement of plasma clozapine concentrations is useful in assessing compliance, optimizing therapy, and minimizing toxicity. We measured plasma clozapine and norclozapine (N-desmethylclozapine) concentrations in samples from 3782 patients (2648 male, 1127 female). No clozapine was detected in 291 samples (227 patients, median prescribed dose 300 mg/d).
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