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Characterization of Admission Types in Medically Hospitalized Patients Prescribed Clozapine

机译：在氯氮平的医疗治疗患者中的入院类型的表征

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Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia; however, rigorous monitoring is required to prevent or detect adverse drug events that contribute to morbidity and mortality. In addition to the Food and Drug Administration (FDA) boxed safety warnings specific to clozapine (agranulocytosis, hypotension, seizures, and cardio-myopathy/myocarditis), other adverse events such as pneumonia and gastrointestinal hypomotility have been reported in the literature to result in hospitalization. Objective: To explore the reasons for medical hospitalization in patients prescribed clozapine, a retrospective chart review was completed. Methods: Adults with schizophrenia or schizoaffective disorder prescribed clozapine were identified if they had a non psychiatric medical admission between 1/1/2003 and 81 112015. Demographics, admitting diagnosis, admitting service type, psychiatric consult information, clozapine dosing, and drug interactions were collected. Results: Overall, 104 patients, representing 248 hospitalizations, were admitted to a medical unit during the study period. The predominant admission types were for the management of either pulmonary (32.2%) or gastrointestinal (19.8%) illnesses. The most common pulmonary diagnosis was pneumonia, accounting for 58% of pulmonary admissions. Further, 61.2% of the gastrointestinal admissions were related to hypomotility, ranging from constipation to death. Clozapine was discontinued owing to neutropenia in 2 patients; however, in both cases concomitant chemotherapy had been given. Conclusion: In patients prescribed clozapine admitted to nonpsychiatric medical settings, gastrointestinal and pulmonary illnesses were common, but not illnesses related to boxed warnings. Additional research is needed to better assess the causality and true incidence of gastrointestinal or pulmonary events associated with clozapine. Furthermore, clinicians must be prepared to prevent, detect, and manage potentially life-threatening events associated with clozapine.
机译：背景：氯氮平是治疗难治性精神分裂症的首选抗精神病药物；然而，需要进行严格的监测，以防止或检测导致发病率和死亡率的不良药物事件。除了美国食品和药物管理局（FDA）针对氯氮平（粒细胞缺乏症、低血压、癫痫发作和心脏肌病/心肌炎）的盒装安全警告外，文献中还报告了其他不良事件，如肺炎和胃肠动力低下，导致住院治疗。目的：通过回顾性分析，探讨氯氮平患者住院的原因。方法：如果患有精神分裂症或分裂情感障碍的成年人在2003年1月1日至81112015年间接受了非精神病医疗入院治疗，则应确定他们是否服用氯氮平。收集人口统计学、入院诊断、入院服务类型、精神科咨询信息、氯氮平剂量和药物相互作用。结果：在研究期间，共有104名患者，代表248名住院患者，被送入医疗单位。主要入院类型为肺部疾病（32.2%）或胃肠道疾病（19.8%）。最常见的肺部诊断是肺炎，占肺部入院人数的58%。此外，61.2%的胃肠道入院与运动障碍有关，从便秘到死亡。2例患者因中性粒细胞减少而停用氯氮平；然而，在这两个病例中，同时进行了化疗。结论：在非精神病医疗机构接受氯氮平治疗的患者中，胃肠道和肺部疾病很常见，但与盒装警告相关的疾病并不常见。需要更多的研究来更好地评估与氯氮平相关的胃肠道或肺部事件的因果关系和真实发生率。此外，临床医生必须做好预防、检测和管理与氯氮平相关的潜在生命威胁事件的准备。

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