Munitz Hanan
Clalit Health Services.
Harefuah. 2012 May;151(5):298-300, 318, 317.
Clozapine has been in use since 1975. It was withdrawn due to its toxic effects on granulocytes. It was reintroduced due to its positive effect on schizophrenia in patients who did not respond to two antipsychotic drugs. These patients suffer from a chronic debilitating disease, with numerous and sometimes chronic hospitalizations. Clozapine also has antiaggression and antisuicide effects, as well as specific effects on the negative symptoms of schizophrenia. There are severe side effects that may appear. These include suppression of granulocytes, cardiotoxic effect on the myocard, as well as cardiac conduction defects. It may also cause weight gain and early appearance of diabetis mellitus. All these side effects require strict and intensive monitoring. Clozapine blood Levels are needed for ascertaining the required dose. This article describes several reasons for the low level of use of clozapine in Israel. These include its side effect profile, tendency to use new medications, the demanding monitoring for side effects and the need for long term treatment to achieve clinical improvement.
氯氮平自1975年开始使用。由于其对粒细胞的毒性作用，它曾被撤市。由于它对两种抗精神病药物治疗无效的精神分裂症患者有积极作用，所以又重新投入使用。这些患者患有慢性衰弱性疾病，会多次住院，有时还会长期住院。氯氮平还具有抗攻击和抗自杀作用，以及对精神分裂症阴性症状的特定作用。可能会出现严重的副作用。这些副作用包括粒细胞减少、对心肌的心脏毒性作用以及心脏传导缺陷。它还可能导致体重增加和糖尿病的早期出现。所有这些副作用都需要严格和密集的监测。确定所需剂量需要检测氯氮平血药浓度。本文描述了以色列氯氮平使用水平较低的几个原因。这些原因包括其副作用情况、使用新药的倾向、对副作用的严格监测以及需要长期治疗才能实现临床改善。
