EFFICACY AND ADVERSE-EFFECTS OF CLOZAPINE IN 4 ELDERLY PSYCHOTIC-PATIENTS

Background: Clozapine is an atypical antipsychotic agent that is effec tive in refractory schizophrenic patients. Older patients may have var ious psychotic manifestations that may not be responsive to typical ne uroleptic therapy. There may also be patient-specific factors-declines in reserve capacity and homeostasis, and age-related changes in the p harmacokinetics and pharmacodynamics of drugs-in older patients that i ncrease their susceptibility to the side effects of psychotropic medic ations. While clozapine has few extrapyramidal side effects, it has ot her side effects that may be problematic in the older population. Meth od: In our geropsychiatric unit, clozapine was prescribed for four pat ients over the age of 65 years. All patients were either experiencing psychotic symptoms refractory to other antipsychotic medications or ha d relative contraindications to a typical neuroleptic. Two of the four were chronic schizophrenics, and three of the four also presented wit h dementia. Results: Two of the four patients did eventually receive r elief of psychotic symptoms from clozapine. All four experienced event s after initiation of clozapine therapy, which included falls (2 patie nts), symptomatic bradycardia (2 patients), and delirium(1 patient). A ll these adverse effects occurred on doses ranging from 6.25 to 37.50 mg/day, and the three patients with moderate-to-severe dementia experi enced these severe adverse effects after administration of the first d ose. Conclusion: Clozapine may be a useful drug for older patients wit h psychotic symptoms; however, at current dosage recommendations, adve rse events may occur, especially on first dose. Well-designed studies need to be performed to assess the effectiveness and dosage ranges for this population.