Antipsychotics

How to Manage Adverse Effects of Clozapine – Part 2

In this episode, we cover practical tips on the management of fever, cardiovascular and cardiometabolic adverse effects related to clozapine use. Dr. Jonathan Meyer provides evidence-based pearls as well as clinical anecdotes.

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How to Manage Adverse Effects of Clozapine – Part 1

In this episode, we cover practical tips on the management of sialorrhea, constipation, sedation, and seizures related to clozapine use. Dr. Jonathan Meyer provides evidence-based pearls as well as clinical anecdotes.

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How to Load Haloperidol Decanoate

This presentation reviews the specifics of how to load haloperidol decanoate. It uses two clinical cases to illustrate real-world situations.

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Antipsychotic Plasma Levels and Adherence

This presentation summarizes the benefits of obtaining antipsychotic plasma levels in nonresponding patients.

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How to Manage an Agitated Patient?

In this episode, we venture into the psychopharmacology of agitation, with a special focus on psychotic agitation. Dr. Michael Jibson (University of Michigan) and Dr. David Osser (Harvard Medical School) shared clinical pearls to treat this challenging situation.

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When to Discontinue Antipsychotics? Reviewing the Evidence

When is the right time to discontinue an antipsychotic in the treatment of schizophrenia? We reviewed the evidence as well as consulting Dr. Ira Glick to help us answer this question.

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Are Drug Interaction Warnings Influenced by Drug Company Promotion? An Interview with Dr. Jeffrey Mattes

Dr. Jeffrey Mattes, psychiatrist in Princeton, New Jersey speaks about drug interaction warnings that appear during electronic prescribing and how these warnings may be influenced by drug company promotion.
This interview is part of a series covering the 2018 ASCP Annual Meeting.

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Clozapine-Induced Sialorrhea: Why Is It Important and How Should You Manage It?

Clozapine-induced sialorrhea increases the risk for aspiration pneumonia and is probably linked to norclozapine’s M1 agonism. In terms of treatment, first-line options are orally applied anticholinergics (atropine drops, ipratropium spray).

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Managing Clozapine-Induced Constipation: Practical Advice

Routine management of constipation is a critical part of clozapine treatment. There are case reports of fatal ileus related to clozapine therapy.

-The first step is to minimize the use of systemic anticholinergics.
-Docusate should be used routinely.  Bulk agents can make constipation worse and should be avoided.
-After docusate, the next agent to add is PEG 3350.
-Lubiprostone, a more expensive agent, can also be tried. It can be used if the combination of docusate + PEG-3350 + a stimulant is not effective.

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Clozapine Augmentation for Treatment-Resistant Schizophrenia: What Does the Evidence Say?

Up to 30% of patients with treatment-resistant schizophrenia treated with clozapine have residual positive symptoms. Clozapine augmentation is a common approach, but the evidence supporting this practice is limited.
According to the latest evidence, risperidone, lamotrigine, topiramate, or ECT are potential augmenting options.

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