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A systematic review of clozapine-associated inflammation and related monitoring
dc.contributor.authorLeung, Jonathan G.
dc.contributor.authorZhang, Lusi
dc.contributor.authorMarkota, Matej
dc.contributor.authorEllingrod, Vicki L.
dc.contributor.authorGerberi, Danielle J.
dc.contributor.authorBishop, Jeffrey R.
dc.date.accessioned2024-01-04T21:57:08Z
dc.date.available2025-01-04 16:57:07en
dc.date.available2024-01-04T21:57:08Z
dc.date.issued2023-12
dc.identifier.citationLeung, Jonathan G.; Zhang, Lusi; Markota, Matej; Ellingrod, Vicki L.; Gerberi, Danielle J.; Bishop, Jeffrey R. (2023). "A systematic review of clozapine-associated inflammation and related monitoring." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy (12): 1364-1396.
dc.identifier.issn0277-0008
dc.identifier.issn1875-9114
dc.identifier.urihttps://hdl.handle.net/2027.42/191802
dc.description.abstractClozapine is an effective antipsychotic medication used for treatment-resistant schizophrenia. However, it is underutilized due to rigorous hematologic monitoring requirements and many adverse drug reactions. Publications have highlighted the occurrence of inflammatory reactions, some life-threatening, particularly during the early stages of clozapine treatment. Although guidelines have suggested monitoring for inflammatory processes during clozapine initiation, screening in clinical practice is not universal. This systematic review aimed to investigate the relationship between clozapine and inflammation and assess the importance of monitoring for inflammatory reactions. A comprehensive literature search yielded 6915 unique publication records after removal of duplicates. After a rigorous screening process, 75 publications were included in the review, which focused on three main aspects: (i) the impact of clozapine on inflammatory markers, (ii) monitoring cardiac and other organ function during clozapine-associated inflammatory processes, and (iii) monitoring non-specific signs and symptoms of inflammation. Elevated levels of C-reactive protein (CRP) and several proinflammatory cytokines have been observed in association with clozapine treatment. However, the practicality of measuring specific markers in clinical practice remains uncertain. Current evidence supports monitoring CRP levels during the first 4–8 weeks of treatment, especially to facilitate myocarditis screening. Further research is needed to establish clinically relevant CRP thresholds for intervention. The implementation of monitoring protocols during the early phase of clozapine treatment may mitigate adverse reactions and allow for continued use of clozapine. Future studies should also explore the association between clozapine-associated inflammation and pneumonia, as well as investigate the impact of inflammation on clozapine metabolism to predict the need for dose adjustment. These endeavors may facilitate the development and implementation of evidence-based guidelines for the monitoring of clozapine-associated inflammation.
dc.publisherWiley Periodicals, Inc.
dc.subject.otherclozapine
dc.subject.othermyocarditis
dc.subject.otherC-reactive protein
dc.subject.othermonitoring
dc.subject.otherinflammation
dc.subject.otherfever
dc.subject.othereosinophilia
dc.titleA systematic review of clozapine-associated inflammation and related monitoring
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelPharmacy and Pharmacology
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/191802/1/phar2887.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/191802/2/phar2887_am.pdf
dc.identifier.doi10.1002/phar.2887
dc.identifier.sourcePharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
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dc.owningcollnameInterdisciplinary and Peer-Reviewed


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