Zhao Victor, Gong Yiting, Thomas Naveen, Das Soumitra
Department of Psychiatry, University of Melbourne, Parkville 3052, Australia.
Department of Psychiatry, Western Health, Footscray 3011, Australia.
Medicina (Kaunas). 2024 Dec 6;60(12):2016. doi: 10.3390/medicina60122016.
Clozapine is a highly effective antipsychotic used for treating treatment-refractory psychotic and mood disorders. However, clozapine also has a serious risk of side effects leading to mortality, particularly its potentiated risk of leading to pneumonia. This review aims to overview the demographic and health-related risk factors leading to pneumonia to better inform risk assessment for clozapine users and to summarise current theories on the mechanisms for clozapine-associated pneumonia. This paper will highlight the need to prioritise pneumococcal vaccination in this population group. We conducted a literary search of five online databases conforming to PRISMA. Our review includes all peer-reviewed papers with original data that discuss clozapine and pneumonia and excludes case reports. Baseline information of participants, pneumonia-related information and information regarding risk factors and mechanisms causing pneumonia were also extracted. Clozapine was found to have an increased risk of pneumonia compared to other antipsychotic medications. Factors included comorbidities, higher clozapine dosages, and concurrent use of other antipsychotic medications. Key mechanisms for clozapine-associated pneumonia include clozapine-induced hyper sedation, sialorrhea and neutropoenia. While clozapine improves overall mortality for patients, our review confirms clozapine has the highest risk of pneumonia of all antipsychotics. The review also highlights the prevalent underuse of pneumococcal vaccines among clozapine users and the urgent need to increase uptake.
氯氮平是一种高效抗精神病药物，用于治疗难治性精神病和情绪障碍。然而，氯氮平也有导致死亡的严重副作用风险，尤其是其引发肺炎的风险更高。本综述旨在概述导致肺炎的人口统计学和健康相关风险因素，以便更好地为氯氮平使用者的风险评估提供信息，并总结目前关于氯氮平相关性肺炎发病机制的理论。本文将强调在这一人群中优先进行肺炎球菌疫苗接种的必要性。我们对符合PRISMA的五个在线数据库进行了文献检索。我们的综述纳入了所有讨论氯氮平和肺炎且有原始数据的同行评审论文，并排除了病例报告。还提取了参与者的基线信息、肺炎相关信息以及导致肺炎的风险因素和机制的信息。结果发现，与其他抗精神病药物相比，氯氮平引发肺炎的风险更高。相关因素包括合并症、更高的氯氮平剂量以及同时使用其他抗精神病药物。氯氮平相关性肺炎的关键机制包括氯氮平引起的过度镇静、流涎和中性粒细胞减少。虽然氯氮平可改善患者的总体死亡率，但我们的综述证实，在所有抗精神病药物中，氯氮平引发肺炎的风险最高。该综述还强调了氯氮平使用者中肺炎球菌疫苗普遍使用不足的情况以及迫切需要提高疫苗接种率。
