Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Acta Psychiatr Scand. 2016 Sep;134(3):234-40. doi: 10.1111/acps.12593. Epub 2016 May 16.
While it is recommended that clozapine be administered in a divided dosing regimen, it is unclear whether this recommendation is followed in real-world clinical practice. In two large datasets, we examined clozapine dosing frequency and patient characteristics across different dosing regimens.
We conducted a cross-sectional survey, collecting data on patients receiving clozapine in August/September 2015 from the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, and The Zucker Hillside Hospital (ZHH) in New York, United States.
Of 676 and 308 patients included in CAMH and ZHH datasets, clozapine was prescribed once daily in 75.1% and 74.4%, even though doses exceeding 200 mg/day were administered in 88.6% and 84.4% of the respective samples. No significant difference was found in the rates of positive symptom remission between once-daily vs. divided dosing (79.7% vs. 80.5%, P = 1.00). Higher clozapine dose and use of anticholinergic medications were significantly associated with divided dosing in both datasets. Older age or male gender was related to divided dosing in CAMH or ZHH dataset respectively.
Despite the product monograph recommendation, clozapine is frequently prescribed once daily in North America. Further studies are needed to compare clinical outcomes between once-daily vs. divided clozapine dosing.
尽管建议将氯氮平分为多次剂量给药，但在实际临床实践中是否遵循这一建议尚不清楚。在两个大型数据集，我们检查了不同剂量方案下氯氮平的给药频率和患者特征。
我们进行了一项横断面调查，于 2015 年 8 月/9 月从加拿大安大略省多伦多的成瘾与心理健康中心（CAMH）和美国纽约的祖克山医院（ZHH）收集接受氯氮平治疗的患者数据。
在 CAMH 和 ZHH 数据集的 676 名和 308 名患者中，尽管分别有 88.6%和 84.4%的样本中给予的剂量超过 200mg/天，但氯氮平仍分别有 75.1%和 74.4%被处方为每日一次。每日一次与分剂量给药之间的阳性症状缓解率无显著差异（79.7%与 80.5%，P=1.00）。在两个数据集均发现，较高的氯氮平剂量和使用抗胆碱能药物与分剂量给药显著相关。在 CAMH 或 ZHH 数据集，年龄较大或男性与分剂量给药相关。
尽管产品说明书有建议，但氯氮平在北美仍经常每日一次给药。需要进一步研究比较每日一次与分剂量氯氮平给药之间的临床结局。
