PMID- 33440269
OWN - NLM
STAT- MEDLINE
DCOM- 20210730
LR  - 20210730
IS  - 1872-7123 (Electronic)
IS  - 0165-1781 (Linking)
VI  - 297
DP  - 2021 Mar
TI  - Clozapine tolerability in Treatment Resistant Schizophrenia: exploring the role 
      of sex.
PG  - 113698
LID - S0165-1781(20)33359-X [pii]
LID - 10.1016/j.psychres.2020.113698 [doi]
AB  - Clozapine is the only evidence-based drug indicated for Treatment Resistant 
      Schizophrenia but it is largely underprescribed, partially due to its 
      life-threatening adverse effects (AEs). However, clozapine treatment is burdened 
      by other common AEs as constipation, hypersalivation, postural hypotension, 
      tachycardia and metabolic abnormalities. Few studies have investigated 
      sex-related differences in clozapine's tolerability, reporting women to 
      experience more frequently weight gain, hyperglycemia and constipation, while men 
      hypertension and dyslipidemia. Based on these premises, we investigated clinical, 
      psychopathological and metabolic sex-related differences among 147 
      treatment-resistant patients treated with clozapine, with a specific focus on 
      non-life-threatening AEs. We observed significant higher prevalence of 
      tachycardia in men, and of orthostatic hypotension and constipation in women. 
      Concerning metabolic alterations, we observed significant lower levels of 
      HDL-cholesterol and higher prevalence of hypertriglyceridemia among men, whereas 
      females showed higher prevalence of abdominal obesity. Consistently with previous 
      studies, our data confirm the presence of sex-related differences in clozapine 
      tolerability, with a main effect of sex especially for tachycardia, postural 
      hypotension and constipation. Although non-life-threatening, these common AEs 
      significantly affect patients' quality of life, undermine compliance and cause 
      treatment discontinuation. A better understanding of this topic could contribute 
      to tailor therapeutic approaches, thus improving tolerability, compliance and 
      clinical stability.
CI  - Copyright (c) 2020 Elsevier B.V. All rights reserved.
FAU - Martini, Francesca
AU  - Martini F
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy. Electronic address: martini1.francesca@hsr.it.
FAU - Spangaro, Marco
AU  - Spangaro M
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
FAU - Buonocore, Mariachiara
AU  - Buonocore M
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy.
FAU - Bechi, Margherita
AU  - Bechi M
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy.
FAU - Cocchi, Federica
AU  - Cocchi F
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy.
FAU - Guglielmino, Carmelo
AU  - Guglielmino C
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy.
FAU - Bianchi, Laura
AU  - Bianchi L
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy.
FAU - Sapienza, Jacopo
AU  - Sapienza J
AD  - Vita-Salute San Raffaele University, Milan, Italy.
FAU - Agostoni, Giulia
AU  - Agostoni G
AD  - Vita-Salute San Raffaele University, Milan, Italy.
FAU - Mastromatteo, Antonella
AU  - Mastromatteo A
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy.
FAU - Bosia, Marta
AU  - Bosia M
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
FAU - Cavallaro, Roberto
AU  - Cavallaro R
AD  - Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, 
      Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
LA  - eng
PT  - Journal Article
DEP - 20201230
PL  - Ireland
TA  - Psychiatry Res
JT  - Psychiatry research
JID - 7911385
RN  - 0 (Antipsychotic Agents)
RN  - J60AR2IKIC (Clozapine)
SB  - IM
MH  - Adult
MH  - Antipsychotic Agents/*adverse effects/therapeutic use
MH  - Clozapine/*adverse effects/therapeutic use
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Quality of Life
MH  - Schizophrenia/*drug therapy
MH  - Sex Factors
OTO - NOTNLM
OT  - Adverse effects
OT  - Antipsychotics
OT  - Constipation
OT  - Gender
OT  - Metabolic alterations
OT  - Orthostatic hypotension
OT  - Tachycardia
EDAT- 2021/01/14 06:00
MHDA- 2021/07/31 06:00
CRDT- 2021/01/13 20:07
PHST- 2020/09/10 00:00 [received]
PHST- 2020/12/28 00:00 [accepted]
PHST- 2021/01/14 06:00 [pubmed]
PHST- 2021/07/31 06:00 [medline]
PHST- 2021/01/13 20:07 [entrez]
AID - S0165-1781(20)33359-X [pii]
AID - 10.1016/j.psychres.2020.113698 [doi]
PST - ppublish
SO  - Psychiatry Res. 2021 Mar;297:113698. doi: 10.1016/j.psychres.2020.113698. Epub 
      2020 Dec 30.