De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study
Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study...
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Format: | Article |
Language: | English |
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SAGE Publishing
2023-01-01
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Series: | Indian Journal of Psychological Medicine |
Online Access: | https://doi.org/10.1177/02537176221140496 |
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author | Abhinav Chichra Niji Rachel Varughese Raviteja Innamuri |
author_facet | Abhinav Chichra Niji Rachel Varughese Raviteja Innamuri |
author_sort | Abhinav Chichra |
collection | DOAJ |
description | Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures. Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001). Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels. |
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issn | 0253-7176 0975-1564 |
language | English |
last_indexed | 2024-04-11T01:19:13Z |
publishDate | 2023-01-01 |
publisher | SAGE Publishing |
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series | Indian Journal of Psychological Medicine |
spelling | doaj.art-2911acdd3b55424282fdd346b93837f62023-01-03T14:35:54ZengSAGE PublishingIndian Journal of Psychological Medicine0253-71760975-15642023-01-014510.1177/02537176221140496De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort StudyAbhinav Chichra0Niji Rachel Varughese1Raviteja Innamuri2 Dept. of Psychiatry Unit Two, Mental Health Centre, Christian Medical College, Vellore-Bagayam campus, Vellore, Tamil Nadu, India. Dept. of Psychiatry Unit Two, Mental Health Centre, Christian Medical College, Vellore-Bagayam campus, Vellore, Tamil Nadu, India. Dept. of Psychiatry Unit Two, Mental Health Centre, Christian Medical College, Vellore-Bagayam campus, Vellore, Tamil Nadu, India.Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures. Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001). Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels.https://doi.org/10.1177/02537176221140496 |
spellingShingle | Abhinav Chichra Niji Rachel Varughese Raviteja Innamuri De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study Indian Journal of Psychological Medicine |
title | De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study |
title_full | De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study |
title_fullStr | De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study |
title_full_unstemmed | De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study |
title_short | De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study |
title_sort | de novo seizures obsessive compulsive symptoms and neutropenias in patients on clozapine a retrospective cohort study |
url | https://doi.org/10.1177/02537176221140496 |
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