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15 - Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution

Published online by Cambridge University Press:  19 October 2021

Jonathan M. Meyer  and
Stephen M. Stahl
Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

Clozapine’s effectiveness for treatment-resistant schizophrenia and mania, and its anti-aggressive properties, has led to trials for younger and older patients with severe mental disorders, and for those with intellectual disability (ID) who have treatment-resistant psychosis or nonpsychotic behavioral disorders. There is a paucity of double-blind data supporting some of these uses, but a compelling picture of efficacy based on case series and a small number of clinical trials. The common theme for these patient groups is managing tolerability concerns through adjustment of initial titration, use of plasma clozapine levels, and careful tracking of adverse effects. Pregnant women represent a patient population with a different set of issues; however, recent developments in the literature on major congenital malformations and first-trimester antipsychotic exposure support the conclusion that atypical antipsychotics as a class are not associated with increased risk. This finding is consistent with the available clozapine case data, and thereby allows clinicians to focus their energies on monitoring for maternal gestational diabetes, and minimization of postnatal exposure to avoid excessive sedation in the newborn. Clinicians should be familiar with the risk nomenclature and data on psychotropics during breastfeeding as a matter of routine clinical competence; however, due to risk of neutropenia, clozapine is the only antipsychotic that is absolutely contraindicated in breastfeeding women.

Type
Chapter
Information
The Clozapine Handbook
Stahl's Handbooks
 , pp. 276 - 306
Publisher: Cambridge University Press
Print publication year: 2019

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