title: Low dose of clozapine in the treatment of dopaminergic psychosis in Parkinson's disease.
abstract: Dopaminergic psychosis frequently complicates the pharmacological treatment of Parkinson's disease. Dose reduction of dopaminomimetic therapy or treatment with conventional neuroleptics improves psychosis but worsens parkinsonism. In an open-label 12-month trial, the clinical antipsychotic efficacy of the atypical neuroleptic clozapine was investigated in 36 parkinsonian patients (age range 46-85 years) with symptoms of dopaminergic psychosis including delusions, vivid dreams, hallucinations, frank paranoid delirium, and hypersexuality. Clozapine, given orally at bedtime, was started at a dose of 6.25 mg and titrated upward to the minimal effective dose. In all patients, psychosis responded to very low clozapine doses (mean 10.59 +/- 6.48 mg/day). Clozapine doses correlated with the severity of psychosis. During clozapine treatment, parkinsonian disabilities and levodopa dosage remained statistically unchanged. During the 12-month study, no patient had clozapine-induced agranulocytosis or other severe side effects. These findings indicate that even at low doses, clozapine effectively controls dopaminergic psychosis in Parkinson's disease patients without compromising motor function.
authors.affiliation: Mediterranean Institute of Neuroscience Neuromed, Pozzilli, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ruggieri
authors.forename: M F
authors.initials: MF
authors.lastname: De Pandis
authors.forename: A
authors.initials: A
authors.lastname: Bonamartini
authors.forename: L
authors.initials: L
authors.lastname: Vacca
authors.forename: F
authors.initials: F
authors.lastname: Stocchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use*; D003702:Delusions; D004298:Dopamine / Q000009:adverse effects*; D005260:Female; D006212:Hallucinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D011605:Psychoses, Substance-Induced / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine; D004298:Dopamine