Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.
Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
Schizophr Res. 2024 Jun;268:233-242. doi: 10.1016/j.schres.2023.03.032. Epub 2023 Mar 29.
To identify the risks and benefits of clozapine‑lithium co-prescription.
Articles published in English or French were identified with a MEDLINE, Web of Sciences and PsycINFO search, from inception through January 2023, using the term 'clozapine' in combination with 'lithium'. Data were synthesized narratively.
Of the 67 articles included in the review, more than half (n = 38, 56.7 %) were focused on clozapine-related blood dyscrasia. A body of evidence drawn from case reports and retrospective chart studies highlights the potential benefits of lithium prescription for clozapine-related neutropenia, since this strategy may avoid clozapine discontinuation or allow its rechallenge. The most documented adverse drug reactions (ADRs) associated with clozapine‑lithium co-prescription are neurotoxic events, which may be prevented or detected early by clinical, electroencephalographic and therapeutic drug monitoring. Causality assessment cannot be established for other reported ADRs occurring during clozapine‑lithium co-prescription. The benefits of the combined prescription on psychotic and/or mood symptoms are poorly documented.
The risks and benefits of clozapine‑lithium co-prescription require further exploration as the combination might significantly contribute to reducing underprescription or premature discontinuation of clozapine.
确定氯氮平-锂联合用药的风险和益处。
通过 MEDLINE、Web of Sciences 和 PsycINFO 搜索，以“氯氮平”和“锂”为关键词，检索了从创建到 2023 年 1 月发表的英文或法文文献，对纳入的文献进行了叙述性综合。
在综述中纳入的 67 篇文章中，超过一半（n=38，56.7%）侧重于与氯氮平相关的血液学异常。病例报告和回顾性图表研究的证据表明，锂处方对氯氮平相关中性粒细胞减少症可能具有潜在益处，因为这种策略可以避免氯氮平停药或允许重新使用氯氮平。与氯氮平-锂联合用药相关的最有记录的药物不良反应（ADR）是神经毒性事件，通过临床、脑电图和治疗药物监测可以早期预防或发现这些事件。对于在氯氮平-锂联合用药期间发生的其他报告的 ADR，无法进行因果关系评估。联合处方对精神病和/或情绪症状的益处记录较少。
氯氮平-锂联合用药的风险和益处需要进一步探讨，因为这种联合用药可能会显著减少氯氮平的低剂量处方或过早停药。
