Clozapine for older adults with severe mental illness: a systematic review and expert recommendations for clinical practice.

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Expert Review of Clinical Pharmacology Pub Date : 2025-06-01 Epub Date: 2025-07-10 DOI:10.1080/17512433.2025.2520926

Hélène Verdoux, Alexis Lepetit, Jose de Leon

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引用次数: 0

Abstract

Introduction: We aimed to synthesize the information relevant for clinical practice on the initiation and adaptation of clozapine treatment in new and long-term older adult users with severe mental illness (SMI).

Methods: Articles were identified with MEDLINE, Web of Sciences and PsycINFO search from inception through March 2025. The search was restricted to studies including clozapine users with SMI aged ≥50 years. Data were synthesized narratively.

Results: We identified 16 studies (14 chart studies, one controlled study, one pharmaco-epidemiological study) including 1244 participants. All observational studies reported a clinical benefit of clozapine, but few used structured assessments. The single controlled study in a small sample did not find clozapine superior to chlorpromazine. No fatal case attributable to clozapine exposure was reported. The increased risks of aspiration pneumonia, constipation, postural hypotension, and falls were identified early by the first chart studies. Most studies included new clozapine users, and none explored the adaptation of clozapine treatment in long-term users reaching old age.

Conclusions: Gaps in knowledge are of particular concern for older adults with SMI who are long-term clozapine users. Further studies are required to document how to adapt clozapine treatment to physiological aging or incident comorbidities and co-prescriptions.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD420251038600.

查看原文本刊更多论文

氯氮平对患有严重精神疾病的老年人的治疗：临床实践的系统回顾和专家建议。

前言：我们的目的是综合有关氯氮平在重度精神疾病（SMI）老年新使用者和长期使用者中开始和适应氯氮平治疗的临床实践的相关信息。方法：通过MEDLINE、Web of Sciences和PsycINFO检索从建站到2025年3月的文章。该研究仅限于年龄≥50岁的重度精神障碍患者氯氮平使用者。数据以叙述的方式合成。结果：我们纳入了16项研究（14项图表研究，1项对照研究，1项药物流行病学研究），包括1244名受试者。所有的观察性研究都报道了氯氮平的临床益处，但很少使用结构化评估。小样本的单对照研究没有发现氯氮平优于氯丙嗪。未见氯氮平暴露致死病例报告。吸入性肺炎、便秘、体位性低血压和跌倒的风险增加是在第一个图表研究中早期发现的。大多数研究包括新的氯氮平使用者，没有研究氯氮平治疗对长期使用者老年期的适应性。结论：对于长期使用氯氮平的重度精神障碍老年患者，知识差距尤其值得关注。需要进一步的研究来证明如何使氯氮平治疗适应生理性衰老或事件合并症和联合处方。协议注册：www.crd.york.ac.uk/prospero标识为CRD420251038600。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.30

自引率

2.30%

发文量

127

期刊介绍： Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.