Metabolic Syndrome Is Common Among Clozapine Patients

Posted Sep 22, 2008.By Michele G. Sullivan

BARCELONA (EGMN) - Metabolic syndrome was present in 61% of patients with schizophrenia who took clozapine, a Dutch observational study has shown.

Women and those taking concomitant mood stabilizers had the highest risk, Dr. Pauline Steylen reported in a poster at the annual congress of the European College of Neuropsychopharmacology.

The study comprised 62 patients (46 male); 50 had a diagnosis of schizophrenia, 7 had schizoaffective disorder, and 5 had an undefined psychotic disorder. All patients were taking clozapine (Clozaril), with a mean duration of 9 years of treatment, and a mean daily dose of 332 mg.

Metabolic syndrome was significantly more common among women and those taking a concurrent mood stabilizer, than among those taking clozapine monotherapy (83% vs 7%).

There were no associations between metabolic syndrome and the dose, treatment duration, or plasma level of clozapine's metabolite. However, some of these factors were significantly associated with some aspects of metabolic syndrome. Higher daily doses were associated with higher cholesterol levels; longer treatment duration was associated with worse levels of high-density lipoprotein; higher plasma clozapine levels were related to higher diastolic and systolic blood pressure; and a higher plasma level of N-desmethylclozapine was associated with higher diastolic blood pressure.

The study found that smokers were taking significantly higher doses of clozapine than were nonsmokers (mean 382 mg/day vs 255 mg/day). Despite this, only 12% of smokers were in remission vs. 64% of nonsmokers.

"Smoking enhances clozapine metabolism, and smoking patients did not show adequate plasma concentrations of clozapine, which probably affected their lower remission status," noted Dr. Steylen of the Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands.