Switching Clozapine Responders to Olanzapine
J Clin Psychiatry 2000;61(12):912-915
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Clozapine is an atypical
antipsychotic indicated for the management of severely ill
patients with schizophrenia who have failed to respond adequately
to standard drug treatment. The significant risk of
agranulocytosis and seizure associated with clozapine has led to
the restrictions in its use. Additionally, drug-induced sedation,
sialorrhea, enuresis, and weight gain are often cited as
problematic consequences of clozapine treatment. Our primary
objective was to determine the effectiveness and safety of a
method of slow cross-titration from clozapine to olanzapine among
patients responsive to clozapine treatment but experiencing
medication-induced adverse events.
Method: Changes in symptomatology, mood,
subjective response, and safety were examined in 20 outpatients
meeting DSM-IV criteria for schizophrenia or schizoaffective
disorder who converted from clozapine to olanzapine. Patients
were considered clozapine-responsive as evidenced by improved
social function and decreased symptoms with clozapine therapy;
however, they were interested in alternative pharmacologic
treatment because of clozapine-related side effects.
Results: Equivalent efficacy of olanzapine to
clozapine was found in 90% of the patients (18/20) in the study
group, without rehospitalization or suicidal behavior in any of
the patients. Also notable was a reduction in drug-induced side
effects and improved subjective response to pharmacotherapy.
Conclusion: The successful conversion from
clozapine to olanzapine has the potential to provide great
benefits for the patient, including reducing drug-induced side
effects while maintaining symptom control. These preliminary
results suggest that further research on converting clozapine
responders to olanzapine is warranted.