An international guideline with six personalised titration schedules for preventing myocarditis and pneumonia associated with clozapine  

作　　者：Jose de Leon Can-Jun Ruan Georgios Schoretsanitis Christopher Rohde Elif Anıl Yağcıoğlu Trino Baptista Oleg O Kirilochev Carlos De las Cuevas Christoph U Correll 

机构地区：[1]Mental Health Research Center,Eastern State Hospital,Lexington,Kentucky,USA 2 Biomedical Research Centre in Mental Health Net(CIBERSAM),Hospital Santiago Apóstol,Vitoria-Gasteiz,Spain 3 Laboratory of Clinical Psychopharmacology,Beijing An Ding Hospital,Beijing,China 4 The National Clinical Research Centre for Mental Disorders&Beijing Key Lab of Mental Disorders,Beijing An Ding Hospital,Beijing,China 5 Psychiatry,University of Zürich,Zurich,Switzerland 6 Psychiatry Research,Zucker Hillside Hospital,Glen Oaks,New York,USA 7 Affective Disorders,Aarhus University Hospital,Aarhus,Denmark 8 Clinical Medicine,Aarhus Universitet,Aarhus,Denmark 9 Psychiatry,Hacettepe Universitesi,Ankara,Turkey 10Physiology,Los Andes University Medical School,Merida,Bolivarian Republic of Venezuela 11Clinical Pharmacology,Astrakhan State Medical University,Astrakhan,Astrahanskaâ,Russian Federation 12Department of Internal Medicine,Dermatology and Psychiatry and Instituto Universitario de Neurociencia(IUNE),Universidad de La Laguna,La Laguna,Spain 13Child and Adolescent Psychiatry,CharitéUniversitätsmedizin Berlin,Berlin,Germany

出　　处：《General Psychiatry》2022年第3期157-162,共6页综合精神医学（英文）

基　　金：Acknowledgements Lorraine Maw at the Mental Health Research Center at Eastern State Hospital,Lexington,Kentucky,USA helped with editing.Ms.Maw declares no competing interest in the last 36 months.

摘　　要：White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing myocarditis or pneumonia during clozapine titrations.Prescribers worldwide are largely unaware of that.Meanwhile,as they worry about agranulocytosis,their clozapine-treated patients are at risk of dying from pneumonia or myocarditis.Consequently,an international guideline with 104 authors from 50 countries/regions was recently published to provide personalised clozapine titration schedules for adult inpatients.This forum article reviews pneumonia and myocarditis occurring during clozapine titration,as well as the three most innovative aspects of this new guideline:(1)personalised titration,(2)C reactive protein(CRP)measures,and(3)dose predictions based on blood levels.Clozapine metabolism is influenced by 3 levels of complexity:(1)ancestry groups,(2)sex-smoking subgroups,and(3)presence/absence of poor metabolizer status.These 3 groups of variables should determine the maintenance dose and speed of clozapine titration;they are summarised in a table in the full-text.The international clozapine titration guideline recommends measuring CRP levels simultaneously with WBC,at baseline and weekly at least for the first 4 weeks of titration,the highest risk period for clozapine-induced myocarditis.

关 键 词：TITRATION SUBGROUPS ABSENCE 

分 类 号：R542.2[医药卫生—心血管疾病]