Shore D, Matthews S, Cott J, Lieberman J A
Division of Clinical and Treatment Research, NIMH, Rockville, MD 20857, USA.
Schizophr Bull. 1995;21(2):333-8. doi: 10.1093/schbul/21.2.333.
In September 1994, the National Institute of Mental Health convened a group of scientists to discuss the clinical effects of rapid clozapine discontinuation, especially in light of the introduction of risperidone for the treatment of schizophrenia. Despite concern over recent reports of clinical deterioration (psychotic exacerbations, somatic withdrawal symptoms, and extrapyramidal side effects) in a few patients abruptly discontinued from clozapine, there is currently insufficient information to determine the magnitude of the problems associated with clozapine withdrawal. However, clinicians are reminded that the withdrawal schedule for clozapine indicates a gradual tapering schedule (unless the patient is experiencing severe side effects); that switching patients from clozapine to risperidone does not mean that such tapering is unnecessary; and that the use of risperidone may not produce all of the same effects as clozapine in some treatment-refractory patients.
1994年9月，美国国立精神卫生研究所召集了一批科学家，讨论快速停用氯氮平的临床效果，特别是鉴于利培酮被引入用于治疗精神分裂症。尽管近期有报道称，少数突然停用氯氮平的患者出现了临床恶化（精神病性症状加重、躯体戒断症状和锥体外系副作用），但目前尚无足够信息来确定与氯氮平撤药相关问题的严重程度。然而，需要提醒临床医生的是，氯氮平的撤药方案表明应逐渐减量（除非患者出现严重副作用）；将患者从氯氮平换用利培酮并不意味着无需逐渐减量；而且在一些难治性患者中，使用利培酮可能不会产生与氯氮平相同的所有效果。
