Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-04T20:13:58.757Z Has data issue: false hasContentIssue false

Valproate as prophylaxis for clozapine-induced seizures: survey of practice

Published online by Cambridge University Press:  02 January 2018

David Taylor
Affiliation:
Maudsley Hospital, Denmark Hill, London SE5 8AZ, email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Aims and Method

To evaluate the prescribing of valproate in clozapine-treated individuals who may be at risk of seizure. We collected point-prevalent clinical characteristics and demographics of all in-patients prescribed clozapine in an acute mental health trust. Data were collected from case notes, electronic records and drug charts, and analysed against a set audit standard.

Results

Data were collected for 81 in-patients. Of all deemed to be at risk of seizure (n=37) only 24% were prescribed valproate at a therapeutic plasma level.

Clinical Implications

The majority of patients prescribed clozapine at risk of seizures were not adequately protected from this risk. Clear guidelines are required.

Type
Original papers
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2008

References

Atkinson, J. M., Douglas-Hall, P., Fischetti, C., et al (2007) Outcome following clozapine discontinuation: a retrospective analysis. Journal of Clinical Psychiatry, 68, 10271030.CrossRefGoogle ScholarPubMed
Ciapparelli, A., Dell'Osso, L., Bandettini di Poggio, A., et al (2003) Clozapine in treatment-resistant patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder: a naturalistic 48-month follow-up study. Journal of Clinical Psychiatry, 64, 451458.Google Scholar
Devinsky, O., Honigfeld, G. & Patin, J. (1991) Clozapine-related seizures. Neurology, 41, 369371.Google Scholar
Devinsky, O. & Pacia, S.V. (1994) Seizures during clozapine therapy. Journal of Clinical Psychiatry, 55 (suppl B), 153156.Google Scholar
Greenwood-Smith, C., Lubman, D.I. & Castle, D.J. (2003) Serum clozapine levels: a review of their clinical utility. Journal of Psychopharmacology, 17, 234238.CrossRefGoogle Scholar
Mcevoy, J. P., Lieberman, J. A., Scott Stroup, T., et al (2006) Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. American Journal of Psychiatry, 163, 600610.Google Scholar
National Institute for Health and Clinical Excellence (2002) Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. Health Technology Appraisal No. 43. (http://www.nice.org.uk/nicemedia/pdf/ANTIPSYCHOTICfinalguidance.pdf).Google Scholar
Pacia, S.V. & Devinsky, O. (1994) Clozapine-related seizures: experience with 5629 patients. Neurology, 44, 22472249.Google Scholar
Sajatovic, M. & Meltzer, H.Y. (1996) Clozapine-induced myoclonus and generalized seizures. Biological Psychiatry, 39, 367370.Google Scholar
Silvestri, R. C., Bromfield, E. B. & Khoshbin, S. (1998) Clozapine-induced seizures and EEG abnormalities in ambulatory psychiatric patients. Annals of Pharmacotherapy, 32, 11471151.Google Scholar
Taner, E., Cosar, B. & Isik, E. (1998) Clozapine-induced myoclonic seizures and valproic acid. International Journal of Psychiatry in Clinical Practice, 2, 5355.CrossRefGoogle ScholarPubMed
Taylor, D., Paton, C. & Kerwin, R. (2007) The Maudsley Prescribing Guidelines (9th edn) Informa Healthcare.CrossRefGoogle Scholar
Taylor, D. M. & Duncan-McConnell, D. (2000). Refractory schizophrenia and atypical antipsychotics. Journal of Psychopharmacology, 14, 409418.CrossRefGoogle ScholarPubMed
Welch, J., Manschreck, T. & Redmond, D. (1994). Clozapine-induced seizures and EEG changes. Journal of Neuropsychiatry and Clinical Neurosciences, 6, 250256.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.