LOW-DOSE OF CLOZAPINE IN THE TREATMENT OF DOPAMINERGIC PSYCHOSIS IN PARKINSONS-DISEASE

Dopaminerpic psychosis frequently complicates the pharmacological trea tment of Parkinson's disease. Dose reduction of dopaminomimetic therap y or treatment with conventional neuroleptics improves psychosis but w orsens parkinsonism. In an open-label 12-month trial, the clinical ant ipsychotic efficacy of the atypical neuroleptic clozapine was investig ated in 36 parkinsonian patients (age range 46-85 years) with symptoms of dopaminergic psychosis including delusions, vivid dreams, hallucin ations, frank paranoid delirium, and hypersexuality. Clozapine, given orally at bedtime, was started at a dose of 6.25 mg and titrated upwar d to the minimal effective dose. In all patients. psychosis responded to very low clozapine doses (mean 10.59 +/- 6.48 mg/day). Clozapine do ses correlated with the severity of psychosis. During clozapine treatm ent, parkinsonian disabilities and levodopa dosage remained statistica lly unchanged. During the 12-month study, no patient had clozapine-ind uced agranulocytosis or other severe side effects. These findings indi cate that even at low doses, clozapine effectively controls dopaminerg ic psychosis in Parkinson's disease patients without compromising moto r function.