title: Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia.
abstract: The aim of this study is to evaluate the safety and effectiveness of rapid clozapine titration in patients with schizophrenia in hospital settings. We conducted a retrospective two-center cohort study to compare the safety and effectiveness of clozapine with different titration rates in treatment-refractory patients with schizophrenia. In the first center, clozapine was started at 25-50 mg followed by 50-100 mg as needed every 6 h on day 1, followed by increases of 50-100 mg/day. In the second center, titration was slower; clozapine initiated with 12.5-50 mg on day 1 followed by increases of 25-50 mg/day. The number of days between starting of clozapine until discharge was shorter in the rapid titration group (22.4 ± 8.72 vs 27.0 ± 10.5, p = 0.1). Number of days of total hospital stay were significantly shorter in the rapid titration group (29.6 ± 10.6 vs 41.2 ± 14.8, p = 0.002). Hypotension was more common in the rapid titration group and one patient had suspected myocarditis. Rapid clozapine titration appeared safe and effective. The length of stay following initiation of clozapine was shorter in the rapid-titration group, although this was not statistically significant. However starting clozapine earlier together with rapid titration has significantly shortened the length of hospital stay in patients with treatment refractory schizophrenia.
authors.affiliation: Department of Psychiatry, Cerrahpaşa Faculty of Medicine, University of Istanbul, Istanbul, Turkey. canaaksoy@yahoo.com.
authors.forename: Cana Aksoy
authors.initials: CA
authors.lastname: Poyraz
authors.affiliation: Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
authors.forename: Armağan
authors.initials: A
authors.lastname: Özdemir
authors.affiliation: Department of Psychiatry, Cerrahpaşa Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
authors.forename: Nazife Gamze Usta
authors.initials: NG
authors.lastname: Sağlam
authors.affiliation: Department of Psychiatry, Cerrahpaşa Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
authors.forename: Şenol
authors.initials: Ş
authors.lastname: Turan
authors.affiliation: Department of Psychiatry, Cerrahpaşa Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
authors.forename: Burç Çağrı
authors.initials: BÇ
authors.lastname: Poyraz
authors.affiliation: Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
authors.forename: Nesrin
authors.initials: N
authors.lastname: Tomruk
authors.affiliation: Department of Psychiatry, Cerrahpaşa Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
authors.forename: Alaattin
authors.initials: A
authors.lastname: Duran
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003024:Clozapine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004351:Drug Resistance / Q000187:drug effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Clozapine; Rapid titration; Schizophrenia