Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan; Department of Psychiatry, Kodama Hospital, Ishinomaki, Miyagi, Japan.
Department of Psychiatry, Tohoku University Hospital, Sendai, Miyagi, Japan.
Psychiatry Res. 2024 Apr;334:115810. doi: 10.1016/j.psychres.2024.115810. Epub 2024 Feb 19.
During clozapine initiation, titration speed and concomitant valproate administration have been reported as risk factors for clozapine-induced fever and myocarditis. We tested the risk of concomitant valproate administration by stratifying patients according to titration rate. Concomitant valproate use was only associated with increased inflammatory adverse events in the slower titration group. The frequency of inflammatory adverse events was approximately 30 % during faster titration, regardless of concomitant valproate administration. However, the faster titration group with valproate had a higher frequency of severe adverse effects such as myocarditis. Clinicians should avoid concomitant valproate administration during clozapine initiation, regardless of titration rate.
在氯氮平起始治疗期间，已经报道了滴定速度和伴随丙戊酸钠给药是氯氮平诱导发热和心肌炎的危险因素。我们根据滴定速度对患者进行分层，以测试伴随丙戊酸钠给药的风险。只有在较慢的滴定组中，伴随丙戊酸钠使用与炎症不良事件增加相关。在较快的滴定过程中，炎症不良事件的发生频率约为 30%，无论是否同时使用丙戊酸钠。然而，在有丙戊酸钠的较快滴定组中，严重不良反应（如心肌炎）的频率更高。无论滴定速度如何，临床医生在氯氮平起始治疗期间都应避免同时使用丙戊酸钠。
