Clozapine-Related Side Effects and Their Management in an Adolescent Population: A Naturalistic Observation Study in an Inpatient Clinic Ergen Popülasyonunda Klozapine Bağlı Yan Etkiler ve Bunların Yönetimi: Yataklı Bir Klinikte Naturalistik Gözlem Çalışması

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Tonyalı A., KARAÇETİN G., Karabağ U., Gültekin Taş Z., Kasap D., Kayan Ocakoğlu B.

Turkish Journal of Child and Adolescent Mental Health, cilt.32, sa.2, ss.101-109, 2025 (Scopus, TRDizin)

Özet

Objectives: We aimed to evaluate the side effects seen in adolescents with clozapine use followed up in an inpatient clinic and the approaches to the treatment of side effects in a naturalistic pattern. Materials and Methods: Sociodemographic data, International Statistical Classification of Diseases and Related Health Problems-10 diagnosis, side effects, management and outcomes, prophylactic treatments for side effects, time to initiation of clozapine and clinical observation scores were recorded. Results: The most commonly reported side effects were extrapyramidal system side effects (n=91, 62.8%), followed by sialorrhea (n=57, 39.3%), fasciculation (n=55, 37.9%), sedation (n=43, 29.7%) and constipation (n=40, 27.4%). Of the serious side effects, seizures occurred in 5 patients (3.4%), neutropenia occurred in 5 patients (3.5%); ileus and myocarditis were not observed. The mean clozapine discharge dose was 323.9 (±124.45) mg/g. The mean number of antipsychotics used before clozapine was 3, and the mean duration from the first treatment initiation, due to a serious psychiatric diagnosis (schizophrenia, bipolar disorder), to clozapine initiation was 18.4 (±24) weeks. Valproic acid was initiated in 108 patients (74%) and topiramate in 4 patients (2.7%) for seizure prophylaxis, as seizures are one of the serious side effects of clozapine. Five patients (3.5%) developed neutropenia. The most common reason for discontinuation of clozapine treatment was non-compliance (n=8, 14%), while five patients (9.4%) were discontinued due to serious side effects or risk of these side effects. Conclusion: In the adolescent population, it is possible to effectively intervene with different options for side effects that may affect treatment adherence due to clozapine treatment; thus preventing discontinuation of treatment and contributing to improving prognosis by reducing the time without effective symptomatic improvement.