LOW-DOSE CLOZAPINE IN THE TREATMENT OF LEVODOPA-INDUCED MENTAL DISTURBANCES IN PARKINSONS-DISEASE

Delusions and other manifestations of psychotic behavior are common si de effects in Parkinson's disease (PD) patients chronically treated wi th dopaminergic drugs. Clozapine, a dibenzodiazepine derivative, is an antipsychotic drug largely devoid of extrapyramidal side effects. We evaluated the effects of low doses of clozapine on the mental and moto r functions in PD patients requiring antipsychotic treatment. Twenty-s even PD patients taking dopaminergic drugs and who had psychotic behav ior received clozapine at 12.5 to 75 mg/d. Fifteen patients received c lozapine for 1 to 11 months (mean, 6.8 months) and seven received it f or 12 to 24 months (mean, 18 months). No patient exhibited motor deter ioration, and the psychotic features disappeared immediately, allowing discontinuation of clozapine after several months in 10 patients. Fif teen patients are still receiving clozapine and are free of psychiatri c symptoms. The clozapine treatment was discontinued after 5 days (25 mg/d) in two patients because of somnolence. No patient developed neut ropenia. Clozapine in low doses is effective in the treatment of drug- induced delusions and hallucinations in PD.