title: Clozapine use in Parkinson's disease: a retrospective analysis of a large multicentered clinical experience.
abstract: We conducted a multicentered, retrospective review of clozapine's (CZP) effects on a range of psychiatric, sleep, cognitive, motor, and sensory disorders in Parkinson's disease (PD). Therapeutic outcomes and adverse events were compared with varying prescribing practices at participating sites. The medical records of 172 consecutive PD patients treated with CZP at four movement disorder clinics were reviewed. Low-dose CZP improved psychiatric symptoms of psychosis, anxiety, depression, hypersexuality, sleep disturbance, and akathisia. Tremor, torticollis, limb dystonia, and pain showed modest rates of improvement. Twenty-three percent of patients withdrew as a result of adverse events or treatment failure. Inpatient CZP initiation did not improve therapeutic efficacy, or reduce adverse events or the withdrawal rate. Low-dose CZP in the outpatient setting is generally an effective and well-tolerated treatment for many of the psychiatric, sleep, motor, and sensory disturbances common to late-stage PD.
authors.affiliation: Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Trosch
authors.forename: J H
authors.initials: JH
authors.lastname: Friedman
authors.forename: M C
authors.initials: MC
authors.lastname: Lannon
authors.forename: R
authors.initials: R
authors.lastname: Pahwa
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: L C
authors.initials: LC
authors.lastname: Seeberger
authors.forename: C F
authors.initials: CF
authors.lastname: O'Brien
authors.forename: P A
authors.initials: PA
authors.lastname: LeWitt
authors.forename: W C
authors.initials: WC
authors.lastname: Koller
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000188:drug therapy*; D009460:Neurologic Examination / Q000187:drug effects; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000188:drug therapy*; D010343:Patient Admission; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D007980:Levodopa; D003024:Clozapine