Clozapine-Related Adverse Events and Managing Inadequate Response-Lecture Presentation

Video Transcription

Video Summary

In this video, Dr. Jonathan Meyer from the University of California, San Diego discusses various aspects of Clozapine, an antipsychotic medication. He starts by addressing the issue of weight gain associated with Clozapine and explains that the primary mechanism behind it is histamine H1 antagonism at the hypothalamic level. He suggests that in addition to diet and exercise, prophylactic use of metformin can help manage weight gain caused by Clozapine. Dr. Meyer also discusses metabolic adverse events associated with Clozapine, such as dyslipidemia and hyperglycemia. He mentions that statins or fibrates are commonly used for managing dyslipidemia, especially when triglyceride levels are high. According to Dr. Meyer, seizures are easily managed and should not be a reason to discontinue Clozapine in most cases. He emphasizes that prophylactic anticonvulsants are unnecessary for over 98% of patients. Dr. Meyer also talks about diagnosing and managing myocarditis and interstitial nephritis in Clozapine-treated patients. He explains that fever in the first eight weeks of treatment should be investigated for these conditions. He mentions using troponin levels and C-reactive protein to diagnose myocarditis, and urges clinicians to be vigilant in looking out for symptoms such as malaise, flu-like symptoms, or chest pain. Dr. Meyer further discusses various hematologic abnormalities seen in Clozapine-treated patients, including leukocytosis, thrombocytopenia, eosinophilia, and anemia. He advises monitoring these abnormalities and distinguishing them from other potential causes. Lastly, Dr. Meyer addresses the management of inadequate response to Clozapine, suggesting options such as adjunctive antipsychotics, electroconvulsive therapy, or other non-antipsychotic augmentation strategies. He reminds healthcare professionals to adjust the titration rate based on individual patient characteristics and to manage side effects effectively to ensure patients can benefit from Clozapine therapy.

Keywords

Clozapine

antipsychotic medication

weight gain

metformin

dyslipidemia

hyperglycemia

seizures

myocarditis

interstitial nephritis