Clozapine in China

Y.-l Tang; P.-X. Mao; F. Jiang; Q. Chen; C.-Y. Wang; Z.-J. Cai; P. B. Mitchell

doi:10.1055/s-2007-993224

Pharmacopsychiatry, Inhaltsverzeichnis

Pharmacopsychiatry 2008; 41(1): 1-9
DOI: 10.1055/s-2007-993224

Review

Clozapine in China

Y.-l. Tang¹ ^, ² , P.-X. Mao¹ , F. Jiang¹ , Q. Chen¹ , C.-Y. Wang¹ , Z.-J. Cai¹ , P. B. Mitchell³

¹Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, China
²Departments of Human Genetics, and Psychiatry & Behavioral Sciences, Emory University School of Medicine; Atlanta, USA
³School of Psychiatry, University of New South Wales, Sydney, Australia

Abstract

Clozapine remains one of the most commonly used antipsychotic medications in China. As China has the largest population internationally on clozapine treatment, its experience and research findings are of keen interest to Western psychiatrists. However, most of the related papers have hitherto been published only in Chinese language journals. Here we review mainly Chinese-language publications on the use of clozapine in China.

A descriptive study based on literature identified from searches of Medline and the China National Knowledge Infrastructure (CNKI) databases (1979-2007), and other hand-picked references.

Unlike the situation in other countries, clozapine is still widely used for a number of psychiatric disorders in China, though the prescription of other second-generation antipsychotics (SGAs) is also increasing. About 25-60% of all treated patients with schizophrenia receive clozapine; and clozapine is preferred by some as a first-line treatment for schizophrenia. Clozapine is also used for other conditions such as mania, treatment-resistant depression and drug abuse. The average daily dose is between 200 and 400 mg. The incidence of leukopenia is 3.92% and agranulocytosis 0.21% in China, with about one third of reported cases of patients with agranulocytosis dying. Weight gain and clozapine-associated diabetes are also commonly reported in the Chinese population.

Clozapine is currently the most commonly used treatment for schizophrenia in China. Chinese psychiatrists need to pay more attention to its potential toxic side effects when they make drug choices.

Volltext

Referenzen

References

1 Potter WZ, Ko GN, Zhang LD, Yan WW. Clozapine in China: a review and preview of US/PRC collaboration. Psychopharmacology (Berl). 1989; 99 Suppl: S87-91
2 Chong MY, Tan CH, Fujii S, Yang SY, Ungvari GS, Si T, Chung EK, Sim K, Tsang HY, Shinfuku N. Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci. 2004; 58 ((1)) 61-67
3 Wu TC, Tang GR. Clinical use of antipsychotics and follow-up study. Chin J Neuropsychiat. 1995; 28 217
4 Xu WR, Zhao BL, Cui Q, Gao MF. A comparative study of clozapine and chlorpromazine on schizophrenia - a double-blind study. Chin J Nerv Ment Dis. 1985; 11 222-224
5 Lin RM, Song CS, Ji ZF, Jin SL, Luo Y. Antipsychotic Use in 3 Psychiatric Hospitals. J Clin Psychol Med. 2002; 12 ((2)) 106-107
6 Mao PX, Tang YL, Wang ZM, Jiang F, Gillespie CF, Cai ZJ. Antipsychotic drug use in 503 Chinese inpatients with schizophrenia. International Journal of Psychiatry in Clinical Practice. 2007; 11 ((1)) 29-35
7 Lieberman JA, Kane JM, Johns CA. Clozapine: guidelines for clinical management. J Clin Psychiatry. 1989; 50 ((9)) 329-338
8 Tang YL, Cai ZJ. Pharmacotherapy of schizophrenia. In: Cai ZJ, Weng YZ, Tang YL, editors. Schizophrenia: From Biology to Treatments (Chinese). 1st ed. Beijing, China: The Science Press 2000: 214-227
9 Stip E, Yan HQ, Lee P. Clozapine in a Chinese population. J Psychiatry Neurosci. 1996; 21 ((4)) 283-284 , (in French).
10 Chi ZM, Dai AQ, Sun L. Analysis of Antipsychotic Use for Outpatients. J Clin Psychol Med. 2002; 12 ((2)) 109-110
11 Si T, He YL, Zhou RY, Wang XD, Shu L, Liu XH. Prescription pattern for patients with schizophrenia in three regions of China. Chin Mental Health J. 2003; 17 ((10)) 537-540
12 Fitton A, Heel RC. Clozapine. A review of its pharmacological properties, and therapeutic use in schizophrenia. Drugs. 1990; 40 ((5)) 722-747
13 Karow A, Schnedler D, Naber D. What would the patient choose? Subjective comparison of atypical and typical neuroleptics. Pharmacopsychiatry. 2006; 39 ((2)) 47-51
14 Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Clinical correlates of clozapine prescription for schizophrenia in China. Hum Psychopharmacol. 2007; 22 ((1)) 17-25
15 Wang LW, Wang ZC. Can clozapine be used as a first-line antipsychotic drug?. Shanghai Arch Psychiatry. 1999; , n11 ((2)) 107-111
16 Lieberman JA, Phillips M, Gu H, Stroup S, Zhang P, Kong L, Ji Z, Koch G, Hamer RM. Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine. Neuropsychopharmacology. 2003; 28 ((5)) 995-1003
17 Yang PD, Ji ZF. The efficacy and related factors of clozapine on first-episode schizophrenia. Chin J Nerv Ment Dis. 1997; 23 155-158
18 Task Force for National Guidelines of Treatment for Schizophrenia . China's National Guidelines of Treatment for Schizophrenia. , Beijing, China: Division of Disease Control of the Ministry of Health; Mental Health Center of China's CDC; Chinese Society of Psychiatry; the Institute of Mental Health, Peking University; 2003;
19 Tang YL, Jiang ZN, Zhai YM, Wu YM. Screening and evaluation of predictive factors among refractory schizophrenics treated with clozapine. Chin J Psychiatry. 1997; 30 ((3)) 157-161
20 Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988; 45 ((9)) 789-796
21 Gu NF, Yin JL, Zhang C. Pharmacokinetic study of clozapine. Zhonghua Shen Jing Jing Shen Ke Za Zhi. 1988; 21 ((5)) 259-262 , , 318.
22 Shen XQ, Hua K, Yan H. Relationship of clozapine concentrations with dosage, response, and side effects in schizophrenia. Chin J Nerv Ment Dis. 1990; 16 ((2)) 90-92
23 Li HD, Yan XH, Zhao JP. Clinical study of pharmacokinetics, pharmacodynamics of clozapine in schizophrenia. Chin J Pharmacy. 1993; 28 ((7)) 419-422
24 Kuang WH, Zhang FC, Lu B. Concentration-response relationship of clozapine. Chin J Nerv Ment Dis. 1994; 20 ((3)) 145-147
25 Zhao JP, Chen YG, Chen JD, Li HD, Peng WX. Pharmacokinetic studies of clozapine: relationship of dosage and concentration and other factors. Chin J Psychiatry. 1996; 29 ((3)) 220-223
26 Chen YG, Zhao JP, Xie GR, Chen JD, Chen XG, Zhu RH, Miu JD, Tan DL, Xu ZA, Lou YG. Relationship of dosage, concentration and treatment response of clozapine. Chin J Psychiatry. 1998; 31 ((2)) 104-107
27 Zhu YG, Li HD, He B. Analysis of clozapine concentrations, response and side effects with ROC curve. Chin J Pharmacy. 1997; 32 ((3)) 167-169
28 Chen G, Xu L, Wang AZ. Clozapine concentrations and treatment response in schizophrenia. Chin J Psychiatry. 1998; 31 ((4)) 242
29 Centorrino F, Baldessarini RJ, Kando JC, Frankenburg FR, Volpicelli SA, Flood JG. Clozapine and metabolites: concentrations in serum and clinical findings during treatment of chronically psychotic patients. J Clin Psychopharmacol. 1994; 14 ((2)) 119-125
30 Yang C, Zhao JP, Liu B, Chen YG. Relationship of the cytochrome P450 1A2 activity, steady concentration of clozapine and treatment response. Chinese Journal of Psychiatry. 2002; 35 ((4)) 202-205
31 Yu D. The correlation between clozapine saliva level and clinical response as well as side effect in patient with schizophrenia. Zhonghua Shen Jing Jing Shen Ke Za Zhi. 1992; 25 ((3)) 165-167 , , 191-2.
32 Shen X, Lu MK, Xie B. Clinical significance of monitoring clozapine concentrations. J Clin Psychol Med. 1997; 7 ((5)) 261-263
33 Wang CY, Zhang ZJ, Li WB, Zhai YM, Cai ZJ, Weng YZ, Zhu RH, Zhao JP, Zhou HH. The differential effects of steady-state fluvoxamine on the pharmacokinetics of olanzapine and clozapine in healthy volunteers. J Clin Pharmacol. 2004; 44 ((7)) 785-792
34 Yu AH, Liu P, Fan WF. Therapeutic drug monitoring for clozapine. Chin J Pharmacol. 1994; 10 ((1)) 27-31
35 Tang Y, Peng CX, Xiao H, Sun J, Weng YY, Jiang XJ, Zhai ST. Clozapine treatment of schizophrenia: a study of concentration-response relationship. J Clin Psychol Med. 2000; 10 ((6)) 335-337
36 Li Y, Weng YZ, Wang CY, Li WB. A preliminary investigation of plasma and red blood cell concentrations of clozapine and treatment response. Chin J Clin Pharmacol. 2002; 18 ((2)) 138-141
37 Wang CY, Xiang YQ, Weng YZ, Zhai YM, Li WB, Cai ZJ. Compliance, dosage and concentration of clozapine maintenance treatment of schizophrenia. Chin J Psychiatry. 2001; 34 ((3)) 138-141
38 Liu HY, Gong CF, Ma ZL. Clozapine, valproate, and carbamazepine in acute mania: an analysis of 84 cases. Journal of Health Psychology. 2002; 10 70-72
39 Liu TB, Gao H, Shen QJ. Treatment of acute mania with cloza-pine combined with lithium carbonate. J Clin Psychol Med. 2000; 6 33-34
40 Lei DF. Treatment of acute mania with clozapine combined with lithium carbonate: Analysis of 20 cases. J Clin Psychosomatic Disorders. 2001; 2 13-14
41 Zhang LD, Cheng JD. A double-blind study of clozapine combined with lithium for acute mania. Shandong Arch Psychiatry. 2002; 1 44-45
42 Bai HP, Li ZS, MA YX, Yu L. Cozapine treatment of 18 cases of organic manic state after brain injury. Chin J Nerv Ment Dis. 1998; ((S1)) 111
43 Yan JX. A double-blind clinical trial of add-on clozapine in the treatment of treatment-resistant depression. Clin J Psychol Med. 2001; 11 ((3)) 45-46
44 Tang YL. Major treatment modalities of heroin addiction. Chin J Drug Abuse Prevent Treat. 1997; 4 ((1)) 9-11
45 Tang YL, Zhao D, Zhao C, Cubells JF. Opiate addiction in China: current situation and treatments. Addiction. 2006; 101 ((5)) 657-665
46 Yang BQ, Xu MZ, Ye XB, Shen HY. Detoxification of heroin addiction with clozapine and scopolamine. Zhejiang Medical Journal. 1995; 16 ((3)) 26-23
47 Hui WY. Detoxification of heroin dependence with methadone combined with scopolamine and clozapine. Chin J Drug Abuse Prevent Treat. 2003; 9 21-22
48 Schrag A. Psychiatric aspects of Parkinson's disease - an update. J Neurol. 2004; 251 ((7)) 795-804
49 Yu SW, Pan DM. Clozapine in the treatment of psychiatric symptoms of Parkinson disease. Sichuan Mental Health Journal. 1995; 8 ((3)) 176-177
50 Yang QH, Wu H, Jing LR, Zhu AL. Clozapine treatment of Parkinson-associated psychiatric symptoms in 13 cases. Clinical Focus. 1995; 22 27-28
51 Huang SX, Feng CX. Clozapine treatment of psychiatric symptoms in Parkinson disease: 2 case report. Chin J Nerv Ment Dis. 1999; 25 ((5)) 15
52 Wang ZW, Zeng LQ, Ren AW, Chen JY. Clozapine treatment of psychiatric symptoms in intractable Parkinson Disease: case report. Chin J Nerv Ment Dis. 2000; 26 ((2)) 36
53 Liu YP, Miao GD. Clozapine for psychiatric symptoms associated with Parkinson disease. Chin J Nerv Ment Dis. 2001; 27 ((4)) 77-78
54 Chen FX, Qin HQ. Clozapine in the treatment of psychiatric symptoms of Parkinson disease. J Clin Psychosom Dis. 2001; 8 ((4)) 36-37
55 Li PH, Heng KL. A comparison of low-doase clozapine and trihexyphenidyl. Sichuan Mental Health Journal. 1995; 8 ((1)) 37-39
56 Bassitt DP, Louza Neto MR. Clozapine efficacy in tardive dyskinesia in schizophrenic patients. Eur Arch Psychiatry Clin Neurosci. 1998; 248 ((4)) 209-211
57 Wang SM. Low-dose clozapine treatment for tardive dyskinesia. Chin J Nerv Ment Dis. 1994; 20 ((6)) 373
58 Han YQ. Clozapine treatment of tardive dyskinesia in 12 cases. Shandong Arch Psychiatry. 1995; 8 ((1)) 24-25
59 Han QK, Ruan J. Analysis of clozapine treatment of tardive dyskinesia. J Clin Psychol Med. 2003; 13 ((1)) 33-34
60 Meltzer HY. Treatment of the neuroleptic-nonresponsive schizophrenic patient. Schizophr Bull. 1992; 18 ((3)) 515-542
61 Perry PJ, Miller DD, Arndt SV, Cadoret RJ. Clozapine and norclozapine plasma concentrations and clinical response of treatment-refractory schizophrenic patients. Am J Psychiatry. 1991; 148 ((2)) 231-235
62 Miller DD. Review and management of clozapine side effects. J Clin Psychiatry. 2000; 61 14 , ; discussion 18-9.
63 Potkin SG, Bera R, Gulasekaram B, Costa J, Hayes S, Jin Y, Richmond G, Carreon D, Sitanggan K, Gerber B. et al . Plasma clozapine concentrations predict clinical response in treatment-resistant schizophrenia. J Clin Psychiatry. 1994; 55 ((Suppl B)) 1-136
64 Hasegawa M, Cola PA, Meltzer HY. Plasma clozapine and desmethylclozapine levels in clozapine-induced agranulocytosis. Neuropsychopharmacology. 1994; 11 ((1)) 45-47
65 Kaladjian A, Bery B, Deturmeny E, Bruguerolle B. Clozapine monitoring: plasma or serum levels?. Ther Drug Monit. 1999; 21 ((3)) 327-329
66 Olesen OV. Therapeutic drug monitoring of clozapine treatment. Therapeutic threshold value for serum clozapine concentrations. Clin Pharmacokinet. 1998; 34 ((6)) 497-502
67 Aymard N, Baldacci C, Leyris A, Smagghe PO, Tribolet S, Vacheron MN, Viala A, Caroli F. Neuroleptic-resistant schizophrenic patients treated by clozapine: clinical evolution, plasma and red blood cell clozapine and desmethylclozapine levels. Therapie. 1997; 52 ((3)) 227-232
68 Tang YL, Mao P, Li FM, Li W, Chen Q, Jiang F, Cai ZJ, Mitchell PB. Gender, age, smoking behaviour and plasma clozapine concentrations in 193 Chinese inpatients with schizophrenia. Br J Clin Pharmacol. 2007; 64 ((1)) 49-56
69 Zhu R, Wang C, Zhao J, Chen Y, Zhou H. Determination of clozapine and its N-demethylated metabolite in serum by gas chromatography-mass spectrometry with selected ion monitoring. Se Pu. 1998; 16 ((4)) 317-320
70 Chang WH, Lin SK, Lane HY, Hu WH, Jann MW, Lin HN. Clozapine dosages and plasma drug concentrations. J Formos Med Assoc. 1997; 96 ((8)) 599-605
71 Lane HY, Chang YC, Chang WH, Lin SK, Tseng YT, Jann MW. Effects of gender and age on plasma levels of clozapine and its metabolites: analyzed by critical statistics. J Clin Psychiatry. 1999; 60 ((1)) 36-40
72 Peng WX, Li HD, Xu SW, Guo ZG. The effect of smoking and sex on pharmacokinetics of clozapine and norclozapine. Chinese Journal of Pharmacy. 1997; 32 ((9)) 541-544
73 He B, Ding YQ, Wang CY. Clozapine-induced leukopenia and agranulocytosis in China. Evaluation and Analysis of Drug Use in Hospital of China. 2003; 3 ((5)) 307-311
74 Hou XX, Ying ML, Zhou JD. Changes of white blood cell count among 1434 patients on clozapine. Chinese Journal of New Drugs and Clinical Remedies. 1989; 8 ((4)) 222-224
75 Kaplan HI, Sadock BJ, Grebb JA. Kaplan and Sadock's Synopsis of psychiatry: behavorial sciences, clinical psychiatry. 7th ed. Baltimore: Williams & Wilkins 1994
76 Yang JS, Zhang WL. Clozapine and agranulocytosis. Shanghai Arch Psychiatry. 1990; n2 ((4)) 190-191
77 Lu MK, Hou XX, Ying ML. Analysis of side effects of clozapine. Chin J Neuropyschiatry. 1991; 24 ((2)) 71-74
78 Alvir JM, Lieberman JA, Safferman AZ, Schwimmer JL, Schaaf JA. Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. N Engl J Med. 1993; 329 ((3)) 162-167
79 Honigfeld G, Arellano F, Sethi J, Bianchini A, Schein J. Reducing clozapine-related morbidity and mortality: 5 years of experience with the Clozaril National Registry. J Clin Psychiatry. 1998; 59 ((Suppl 3)) 3-7
80 Janicak PG. Principles and practice of psychopharmacotherapy. 3rd ed. Philadelphia: Lippincott Williams & Wilkins 2001
81 Chen B, Lu MK. Clozapine-associated agranulocytosis: an analysis of 30 patients]. Shanghai Arch Psychiatry. 1997; n9 278-279
82 Zhao HQ. Handbook of Psychotropic Treatments. 1st ed. Beijing, China: People's Military Medical Press 1998
83 Zhao HJ, Qiu ZH. ECK analysis of 260 patients on clozapine. Adverse Drug Reactions Journal. 2000; 2 ((3)) 25-27
84 Zhang GF, Hou G, Zhang XB. An analysis of cardiac side effects associated with clozapine. J Clin Psychol Med. 2004; 14 ((4)) 210-212
85 Zhan CY, Wu LZ. Large-dose clozapine and variations of QT interval. Shanghai Arch Psychiatry. 2001; 13 ((4)) 199-200
86 Peng HS, Wu GH. Effect of high dose clozapine on the variation of QT interval. J Clin Psycho Med. 2002; 12 ((4)) 11-12
87 Liu GJ. Clozapine-induced frequent ventricular premature and bigeminy: a case report. Sichuan Mental Health. 1994; 7 ((2)) 93
88 Luo JG. Adam-Stokes syndrome associated with clozapine in two cases. Sichuan Mental Health. 2003; 16 ((1)) 55
89 Zhang DL, Meng QL. Clozapine-induced large-area cardiac infarct. Adeverse Drug Reactions Journal. 2000; 2 ((3)) 4
90 Liu YZ. Acute myocardial damage associated with clozapine. Journal of Practical Electrocardiology. 2000; 8 ((3)) 4
91 Zheng XJ, Ma JH, Zhao XQ, Tang GM, Gao ZS. Severe cardiac toxicity associated with clozapine in two cases. J Clin Psycho Med. 2002; 12 ((1)) 64
92 Ma Q, Dong YY, Lu YM. Relatioship of clozapine-induced hypersalivation and daily dosage. Shanghai Arch Psychiatry. 1997; 9 ((4)) 276-277
93 Gong QQ, Shi HZ, Wang WX. Clozapine-induced hypersalivation and daily dosage. J Clin Psychosomatics Dis. 1998; 5 ((4)) 34-35
94 Croissant B, Hermann D, Olbrich R. Reduction of side effects by combining clozapine with amisulpride: case report and short review of clozapine-induced hypersalivation-a case report. Pharmacopsychiatry. 2005; 38 ((1)) 38-39
95 Schneider B, Weigmann H, Hiemke C, Weber B, Fritze J. Reduction of clozapine-induced hypersalivation by pirenzepine is safe. Pharmacopsychiatry. 2004; 37 ((2)) 43-45
96 Hu YH. Acupuncture treatment of clozapine-induced hypersalivation. Shanghai Journal of Acupuncture and Moxibustion. 1994; 13 ((2)) 27
97 Qu XQ. Effect of acupuncture on clozapine-induced salivation. Proceeding of Clinical Medicine. 2003; 10 ((3)) 17-18
98 Guan HY, Pan YF, Guo LT. Doxepin treatment of clozapine-induced hypersalivation: a clinical observation. Chin J Civil Med. 1995; 7 ((1)) 23-24
99 He Z, Cheng FX. Comparison of Artane and doxepin in the treatment of clozapine-induced hypersalivation. Clin J Psychol Med. 1999; 9 ((3)) 39
100 Wang HY, Jiang LH, Ma ZF, Zhang LL, Lu YK. Cyproheptadine in the treatment of clozapine-associated hypersalivation: analysis of 100 cases. Shandong Arch Psychiatry. 1994; 7 30-31
101 Li DD, Xu MX, Duan XL. Comparison study of cyproheptadine and propantheline for clozapine-induced hypersalivation. Occupation and Health. 2003; 19 ((10)) 180-181
102 Xue SJ, Lu XB. Diphenhydramine treatment of clozapine-induce hypersalivation. Chin J New Drug Clin Remedies. 1997; 16 34-35
103 Gong GQ, Yu K, Yuan LX, Tan DL, Tang ZR. Treatment of clozapine-induced hypersalivation with diphenhydramin. Sichuan Mental Health. 1997; 10 62
104 Zhang FX, Cui GQ. Analysis of liver damage associated with clozapine use in 32 cases with schizophrenia. Sichuan Mental Health Journal. 1999; 9 ((1)) 60
105 Cheng FD, Lu YZ, Zhai YM, Wang YC, Wu FL. Liver damage associated with clozapine. Adverse Drug Reactions Journal. 1999; 1 ((2)) 52
106 Fu CA, Zhou YX. Severe liver damage associated with clozapine: a case report. Herald of Medicine. 2003; 21 ((10)) 733
107 Shi XM, Cheng XF, Yao SW. Effect of clozapine and coventional antipsychotics on glucose levels of schizophrenia patients. Sichuan Mental Health Journal. 2000; 13 174-175
108 Li G, Wang LL. Clozapine-associated hyperglycemia and related factors. J Clin Psycho Med. 2002; 12 ((4)) 218
109 Xiao CL, Zhou TX, Zhang SP. A comparison of the effect of clozapine and risperidone on glucose-regulation. Shanghai Arch Psychiatry. 2002; 14 201-204
110 Zheng YJ, Wang GH, Cheng ZL. The effect of clozapine and risperidone on glucose-regulation in first-episode schizophrenia. Chin J Psychiatry. 2003; 36 ((4)) 207-210
111 Xi W. A preliminary analysis of clozapine-associated hyperglycemia. Sichuan Mental Health. 2000; 13 ((3)) 169-170
112 Zuo JH, Jia HX, Lu RZ. Clinical analysis of clozapine-associated diabetes. Tianjing Pharmacy. 2001; 13 ((2)) 47
113 Liu Y, Zhu YH, Lu WH. Diabetes in Chinese psychiatric patients. Shanghai Arch Psychiatry. 2001; 13 29-31
114 Zhang WY, Wang XD, Tao JRea. Effect of clozapine on insulin sensitivity. J Clin Psycho Med. 2002; 12 ((4)) 196-197
115 Liu Y, Li HF, Wang HF. et al . Effect of clozapin and risperidone on the level of glucose and insulin in schizophrenic patients. Shanghai Arch Psychiatry. 2003; 15 ((5)) 257-259
116 Chen Q, Tang YL, Mao PX, Cai ZJ. Effect of clozapine and risperidone on the glucose-regulating mechanism in schizophrenic patients. Chin J Clin Rehab. 2005; 9 ((4)) 116-118
117 Zhou Y, Wang GH, Wang HL. et al . Different effects of risperidone and clozapine on insulin secretion in rat islets of Langerhans in vitro. Chin J Psychiatry. 2004; 37 ((4)) 116-118
118 Xia SX, Gao YZ, Bian SZ, Bu M, Li YS. Cardiogenic sudden death induced by clozapine. Journal of Forensic Medicine. 2004; 9 ((1)) 52
119 Zhang LY, Yan B, Li XY, Sun XZ. Hypokalemia and cardiogenic shock in a patient on clozapine. Chinese Journal of Nervous and Mental Diseases. 1999; 25 ((6)) S1
120 Sun BM. Cardiogenic shock induced by low-dose clozapine. Shandong Arch Psychiatry. 1995; 1 ((4)) 51
121 Li GX, Jin XG. Clozapine induced shock after first dose: 12 cases. China Pharmacist. 2000; 3 ((1)) 27-28
122 Wang LP, Zhao CX, Sun ZJ. Death caused by throat swelling and suffocation induced by clozapine: a case report. Chin J Nerv Ment Dis. 1992; 84
123 Lin JM. Clozapine-induced asphyxia: a case report. Strait Pharmaceutical Journal. 1995; 7 ((4)) 15
124 Yan JX, Huang GW, Hu GP, Hou XC. Clozapine-induced respiratory arrest. Chin J Psychiatry. 2004; 37 ((2)) 31
125 Li YQ, Xiao SK. A case died of clozapine-induced skin rush and agranulocytosis. Chongqing Medical Journal. 1994; 23 ((3)) 192
126 Huang XQ. A case died of acute myeloblastic leukemia after clozapine tretment. Chinese Journal of Psychiatry. 1998; 31 ((4)) 13
127 Jia YF. Death due to severe bone marrow suppression by clozapine: 2 cases report. Modern Journal of Integrated Traditional Chinese Medicine and western medicine. 2004; 13 ((9)) 19
128 Ma WL, Guo Y, Shan YM, Xue WP, Guan DW. Death cased by clozapine overdose. Chinese Journal of Forensic Medicine. 2000; 15 ((2)) 42-43
129 Marinkovic D, Timotijevic I, Babinski T, Totic S, Paunovic VR. The side-effects of clozapine: a four year follow-up study. Prog Neuropsychopharmacol Biol Psychiatry. 1994; 18 ((3)) 537-544
130 Fan JX. Relationship between blood clozapine concentrations and effects on ECG. Sichuan Mental Health. 1998; 11 276-277
131 Zwaag C Van der, MacGee M, MacEvoy JP, Freudenreich O, Wilson WH, Cooper TB. Response of patients with treatment-refractory schizophrenia to clozapine within three serum level ranges. Am J Psychiatry. 1996; 153 ((12)) 1579-1584

Correspondence

Y.-l. TangMD, PhD

Department of Human Genetics

and Department of Psychiatry and Behavioral Sciences

Emory University

615 Michael Street

Suite 301

Atlanta

GA 30322

Telefon: +404/727 20 27

Fax: +404/727 57 64

eMail: ytang5@emory.edu