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Clozapine Once-Versus Multiple-Daily Dosing Regimen: A Single-Center, Retrospective, Cross-Sectional Study.

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In China, most clozapine patients use divided doses, achieving higher therapeutic plasma levels than once-daily dosing. Divided dosing is recommended for optimal clozapine treatment in Chinese populations.

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Area of Science:

  • Pharmacology
  • Psychiatry
  • Clinical Pharmacy

Background:

  • Clozapine's short half-life necessitates divided dosing for therapeutic efficacy.
  • Once-daily clozapine dosing is established in several countries but its use in China is not well-documented.
  • This study investigates clozapine dosing regimens in a Chinese patient cohort.

Purpose of the Study:

  • Compare patient characteristics, psychiatric symptoms, and side effects between once-daily and divided clozapine dosing.
  • Determine the optimal clozapine dosage for achieving therapeutic plasma concentrations (350-600 ng/mL) in Chinese patients.
  • Evaluate the real-world adoption of once-daily versus divided clozapine dosing in China.

Main Methods:

  • A retrospective, cross-sectional study was conducted at a single center in China.
  • Data were collected from 198 clozapine-treated patients between March 2019 and March 2021.
  • Patient demographics, dosing regimens, plasma clozapine levels, and clinical outcomes were analyzed.

Main Results:

  • 80% of Chinese patients received divided clozapine doses.
  • Once-daily dosing resulted in significantly lower average plasma clozapine concentrations (158.75 ng/mL) compared to divided dosing (373.34 ng/mL).
  • Only 8% of once-daily users and 28% of divided-dose users achieved therapeutic plasma levels; remission rates were similar, but divided dosing had more adverse effects.

Conclusions:

  • Chinese clinicians predominantly use divided clozapine dosing, especially for doses exceeding 50 mg daily.
  • Divided dosing appears more effective in achieving therapeutic plasma clozapine concentrations in the Chinese population.
  • Further research is needed to assess the clinical outcomes of once-daily clozapine dosing in China.