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klozapin
Clozapine ...

(Specialiserad vård)
2017-12-14 Expertråd psykiatriska sjukdomar

Beslut

Kvarstår

Indikation

Psykos - terapiresistent psykossjukdom

Förbehåll / Kommentar

Medel vid terapirefraktär schizofreni. Behandlingen bör kontrolleras av psykiater.
 
Agranulocytos utvecklas hos cirka 0,8 procent av klozapinbehandlade patienter vilket kräver fortlöpande kontroll av granulocytvärden. Indikation, behandlingseffekt och blodmonitorering bör handläggas av psykiatriker.

Generisk substitution tillämpas vid expedition på recept.

Klozapin är miljöklassificerat. Den goda kliniska effekten för utvalda patienter väger tyngre än en ofördelaktig miljöprofil.

Motivering

Klozapin har ensamt en fastställd effektivitet hos patienter med schizofreni som inte svarat på konventionella antipsykotiska medel.


Utredningsmaterial och referenser

  1. Tuunainen A, Wahlbeck K, Gilbody SM. Newer atypical antipsychotic medication versus clozapine for schizophrenia. Cochrane Database Syst Rev 2000;(2):CD000966. PubMed
  2. Wahlbeck K, Cheine M, Essali MA. Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database Syst Rev 2000;(2):CD000059. PubMed
  3. Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry 2004;161:1334-49. PubMed
  4. Davis JM, Chen N, Glick ID. A meta-analysis of the efficacy of second-generation antipsychotics. Arch Gen Psychiatry 2003;60:553-64.PubMed
  5. Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, Ambler D, Puglia M et al. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry. 2008 Nov;165(11):1420-31. Epub 2008 Sep 15. PubMed
  6. Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM. Comparative efficacy and tolerability of 15 antipsychotic drugs in
    schizophrenia: a multiple-treatments meta-analysis. Lancet. 2013 Sep 14;382(9896):951-62. doi: 10.1016/S0140-6736(13)60733-3. Epub 2013 Jun 27. Review. Erratum in: Lancet. 2013 Sep 14;382(9896):940.
  7. Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009 Jan 3;373(9657):31-41. doi: 10.1016/S0140-6736(08)61764-X. Epub 2008
    Dec 6.
  8. Komossa K, Rummel-Kluge C, Schwarz S, Schmid F, Hunger H, Kissling W, Leucht S. Risperidone versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD006626. doi: 10.1002/14651858.CD006626.pub2. Review.
  9. Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, Kissling W, Leucht S. Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006654. doi: 10.1002/14651858.CD006654.pub2. Review.
  10. Asenjo Lobos C, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Leucht S. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD006633. doi: 10.1002/14651858.CD006633.pub2. Review.
  11. Komossa K, Rummel-Kluge C, Schmid F, Hunger H, Schwarz S, Srisurapanont M, Kissling W, Leucht S. Quetiapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006625. doi: 10.1002/14651858.CD006625.pub2. Review. Update in: Cochrane Database Syst Rev. 2013;11:CD006625.
  12. Essali A, Al-Haj Haasan N, Li C, Rathbone J. Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000059. doi: 10.1002/14651858.CD000059.pub2. Review.
  13. Krzystanek M, Krupka-Matuszczyk I. An open, large, 6-month naturalistic study  of outcome in schizophrenic outpatients, treated with olanzapine. Hum Psychopharmacol. 2011 Jan;26(1):81-5.
  14. Tiihonen J, Wahlbeck K, Lönnqvist J, Klaukka T, Ioannidis JP, Volavka J, Haukka J. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ. 2006 Jul 29;333(7561):224. Epub 2006 Jul 6.
  15. Antipsychotic drugs for the acute treatment of patients with a first episode of schizophrenia: a systematic review with pairwise and network meta-analyses. Zhu Y1, Krause M2, Huhn M2, Rothe P2, Schneider-Thoma J2, Chaimani A3, Li C4, Davis JM5, Leucht S6. Lancet Psychiatry. 2017 Sep;4(9):694-705. doi: 10.1016/S2215-0366(17)30270-5. Epub 2017 Jul 20.
  16. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. Leucht S1, Leucht C1, Huhn M1, Chaimani A1, Mavridis D1, Helfer B1, Samara M1, Rabaioli M1, Bächer S1, Cipriani A1, Geddes JR1, Salanti G1, Davis JM1. Am J Psychiatry. 2017 May 25:appiajp201716121358. doi: 10.1176/appi.ajp.2017.16121358

Bedömning utförd av

Expertrådet för psykiatriska sjukdomar