The safety of clozapine in the elderly

Abstract

Background: Clozapine was the first atypical ‘broad spectrum’ antipsychotic drug to be marketed and the first agent approved for the treatment of schizophrenia refractory to other medications. It is also effective for the treatment of aggressive behaviour in schizophrenic and demented patients and in the management of psychosis and aggression in Parkinson's disease and Lewy body dementia. Objective: The aim of this review is to study the safety of clozapine for use in elderly patients. Methods: An extensive Medline search was made. Some studies that were referenced in reports from our pharmacovigilance centre and from regulatory agencies such as the FDA, EMEA and WHO were included. Conclusions: Clozapine treatment in the elderly requires a careful geriatric assessment. However, its use is strongly limited by the possibility of onset of severe adverse effects such as potentially fatal agranulocytosis, myocarditis and others such as seizures, weight gain and metabolic adverse effects.

Keywords::

• adverse effects
• agranulocytosis
• clozapine
• cytochromes
• elderly
• genetic polymorphism
• safety