ssrpk wrote:
C. admit the patient, stop drug, start broad spectrum antibiotic.
clozapine - agranulocytosis isa drastic complication
Agreed but the Agranulocytosis is present in only 1-2% pts though a very Imp SE of this Drug. I was Thnking of Lithium.
Edited by new_n_lost on 07/02/07 - 03:51 PM
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from
http://www.dialogues-cns.org/brochures/20/htm/20_...
Clozapine Despite some recent reservations, clozapine remains the gold standard for the treatment of TRS, being the only drug with proven superiority to both chlorpromazine in rigorously defined TRS19 and other classic neuroleptics.
A still unresolved question is whether clozapine does indeed have unique intrinsic proprieties that make it effective in TRS or whether its higher efficacy over the classic antipsychotics is secondary to its better tolerabil- ity (no EPS and an upper ceiling for doses). In fact, the possibility that clozapine might have unique intrinsic properties that confer its advantage over the rest of the antipsychotics has generated a large number of investi- gations to elucidate its mechanism of action. Its relatively weaker affinity for, and lower occupancy of, nigrostria- tum dopamine D2 receptors, its D2/5-HT2 (serotonin receptor) ratio, its anticholinergic and cholinomimetic activities, as well as its selectivity for putative brain areas have all been suggested to explain clozapine’s unique clinical properties. Despite the fact that no agreement exists as to what mechanism mediates clozapine’s unique clinical profile, most of the novel antipsychotic drugs were modeled on it
Mood-stabilizing drug treatments Most of the data on adjunct medications are on lithium and anticonvulsants. Several studies indicated a benefi- cial effect of lithium in TRS patients.135-138 However, these studies used loose definitions of TRS and small samples. Definitive evidence of a significant efficacy of lithium has not been presented yet. This could be because the pre- liminary trials are not sufficiently encouraging or because there is no sufficient commercial incentive to invest in a large (expensive) trial to provide definitive evidence.
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