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Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review

Pardis, Parnian et al.

Journal of psychopharmacology. Volume 33:Number 10 (2019); pp 1187-1198 -- Sage Publications

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  • Title:
    Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review
  • Author: Pardis, Parnian;
    Remington, Gary;
    Panda, Roshni;
    Lemez, Milan;
    Agid, Ofer
  • Found In: Journal of psychopharmacology. Volume 33:Number 10 (2019); pp 1187-1198
  • Journal Title: Journal of psychopharmacology
  • Subjects: Psychopharmacology--Periodicals; Schizophrenia--clozapine--tardive dyskinesia--extrapyramidal symptoms--antipsychotics; Dewey: 615.78
  • Rights: legaldeposit
  • Publication Details: Sage Publications
  • Abstract: Background:

    It is commonly recommended that a switch to clozapine be implemented in the face of tardive dyskinesia, even if current treatment involves another "atypical" agent. However, reports do indicate clozapine carries a liability for tardive dyskinesia.

    Aims:

    This review sought to evaluate clozapine in relation to tardive dyskinesia in the context of available evidence.

    Methods:

    Medline, Embase, and PsycINFO databases were searched for studies published in English, using the keywords: clozapine AND tardive dyskinesia OR TD . References from major review articles were searched for additional relevant publications. Studies were included if they investigated: tardive dyskinesia in clozapine-treated patients diagnosed with schizophrenia spectrum disorders, and reported on two or more assessments of tardive dyskinesia severity measured by the Abnormal Involuntary Movement Scale; or clozapine's tardive dyskinesia liability.

    Results:

    In total, 513 unique citations were identified and 29 reports met the inclusion criteria. Thirteen studies suggest clozapine reduces dyskinetic symptoms over time ( n= 905 clozapine-treated participants); however, the minimum required dose and effect of withdrawal requires further investigation. The majority of reports which address clozapine's liability for tardive dyskinesia are case studies (11 of 14 reports, 79%), and clozapine was only the first-line treatment in one of the remaining three studies reporting treatment-emergent dyskinetic symptoms with clozapine in 12% of patients. No significant between-drug differences were identified comparing clozapine's risk to other atypical antipsychotics.

    Conclusions:

    Research to date supports switching to clozapine for the purpose of reducing tardive dyskinesia risk and/or treating existing tardive dyskinesia, but prospective randomized controlled trials are necessary if we are to substantiate existing recommendations.


  • Identifier: System Number: LDEAvdc_100089236557.0x000001; Journal ISSN: 0269-8811; 10.1177/0269881119862535
  • Publication Date: 2019
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

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