Ifteni P, Nielsen J, Burtea V, Correll C U, Kane J M, Manu P
Faculty of Medicine, Transilvania University, Brasov, Romania.
Acta Psychiatr Scand. 2014 Jul;130(1):25-9. doi: 10.1111/acps.12241. Epub 2013 Dec 20.
Clinical guidelines recommend slow clozapine dose titration in order to decrease the risk of seizures and hypotension. The recommendation may delay adequate control of severe psychotic symptoms. We evaluated the safety and effectiveness of rapid clozapine titration in patients who had been previously exposed to the drug and in patients who received clozapine for the first time after failing to respond to other antipsychotics.
Analysis of hospital course of a consecutive cohort of schizophrenia patients (N = 111) who received 25-100 mg of clozapine as needed every 6 h the first treatment day, followed by upward adjustments of 25-100 mg/day.
Symptom control was obtained with an average dose of 353 ± 174 mg/day after 4.1 ± 3.1 days in the 73 patients previously treated with clozapine. For the 38 patients initially started on other antipsychotics, the average clozapine dose required for symptom control (409 ± 188 mg/day) was reached after 7.1 ± 4.8 days. None of the patients had seizures, severe hypotension or other major adverse reactions.
In this naturalistic cohort study rapid clozapine titration appeared safe and effective for the treatment of schizophrenia. The results justify controlled clinical trials of this treatment method.
临床指南建议缓慢滴定氯氮平剂量，以降低癫痫发作和低血压的风险。这一建议可能会延迟对严重精神症状的充分控制。我们评估了快速滴定氯氮平在既往接触过该药物的患者以及在对其他抗精神病药物治疗无效后首次接受氯氮平治疗的患者中的安全性和有效性。
分析一组连续的精神分裂症患者（N = 111）的住院病程，这些患者在治疗的第一天每6小时按需服用25 - 100毫克氯氮平，随后每天增加剂量25 - 100毫克。
73例既往接受过氯氮平治疗的患者在4.1 ± 3.1天后，平均剂量为353 ± 174毫克/天，症状得到控制。对于最初使用其他抗精神病药物治疗的38例患者，在7.1 ± 4.8天后达到症状控制所需的平均氯氮平剂量（409 ± 188毫克/天）。没有患者出现癫痫发作、严重低血压或其他严重不良反应。
在这项自然队列研究中，快速滴定氯氮平治疗精神分裂症似乎是安全有效的。这些结果为该治疗方法的对照临床试验提供了依据。
