Latest news with #Clozapine
Medscape
7 days ago
- Health
- Medscape
Clozapine May Up Infection Risk in Schizophrenia
TOPLINE: Clozapine use was associated with a 25% higher risk for infections in patients with schizophrenia than the use of olanzapine, with a 45% higher risk in those aged 55 years or older, a large cohort study showed. METHODOLOGY: The population-based cohort study included electronic health record data from the Hong Kong Hospital Authority for more than 11,051 adults with schizophrenia. Participants had used clozapine (n = 1450; mean age, 41 years; 52% women) or olanzapine (n = 9601; mean age, 45 years; 55% women) continuously for 90 or more days and had previously used at least two other antipsychotic medications, representing a cohort with treatment resistance. The primary outcome was occurrence of any infectious disease, with subtypes analyzed as secondary outcomes. Medication was initiated from 2004 to 2023, with 2002-2003 as a wash-out period. Mean follow-up periods for clozapine and olanzapine users were about 6.9 years and 5 years, respectively. TAKEAWAY: Overall, 3551 cases of infections were observed during the study. Clozapine use was associated with a significantly greater risk for infection than olanzapine use (weighted hazard ratio [HR], 1.25; P < .0001). Risk for infection from use of clozapine vs olanzapine increased with age: 18-44 years (weighted HR, 1.24; P = .002), 44-54 years (weighted HR, 1.41; P = .001), and 55 years or older (weighted HR, 1.45; P = .002). Risk for upper and lower respiratory tract infections was also significantly higher with use of clozapine vs olanzapine (weighted HRs, 1.50 and 1.71, respectively; P < .0001 for both) as was the risk for gastrointestinal infections (weighted HR, 1.90; P = .0001). Although men and women both had significantly greater infection risk with use of clozapine vs olanzapine, the rate was greater in men (weighted HRs, 1.32 and 1.18, respectively). IN PRACTICE: The investigators noted that although there have been calls to relax current requirements for regular hematological monitoring when using clozapine, their findings 'underscore the importance of regular follow-up to identify early and manage infections, which possibly arise because of a weakened immune system.' Authors of an accompanying editorial noted that patients receiving higher doses might be at even greater risk for adverse events. 'An intermediate balance of personalized dosing designed to limit clozapine-induced inflammation and regular blood testing and physical monitoring…could offer a safe and less invasive compromise to maximize the number of patients receiving clozapine treatment,' the editorial authors wrote. SOURCE: The study was led by Yuqi Hu, the University of Hong Kong, Hong Kong. The editorial was led by Scott R. Clark, University of Adelaide, Adelaide, Australia. Both were published online on July 28 in The Lancet Psychiatry. LIMITATIONS: The study was limited by its observational design, which may have introduced selection bias, and by the absence of key covariates, including socioeconomic status and lifestyle factors. It also lacked laboratory data on drug levels and immune function and only captured infections requiring secondary or tertiary care. Additional constraints included unmeasured anticholinergic effects, a predominantly Chinese cohort that limited generalizability, and not including patients with lived experience. DISCLOSURES: The study was partially supported by the Laboratory of Data Discovery for Health funded by AIR@InnoHK. Some of the study investigators and editorialists reported having financial, advisory, or employment ties with various sources, including pharmaceutical companies. Full details are provided in the original articles. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Arab Times
19-07-2025
- Health
- Arab Times
Common medications you shouldn't take with coffee
NEW YORK, July 19: For many people, a day isn't complete without coffee. It's energizing and widely enjoyed worldwide. However, caffeine in coffee can interfere with some medicines, affecting how well they work or causing unwanted side effects. Tea also contains caffeine but usually in smaller amounts, so its impact differs. Here's what you need to know about coffee's effects on common medications—and how to use them safely. 1. Cold and flu medications Caffeine is a stimulant, as is pseudoephedrine, a common decongestant in cold remedies like Sudafed. When taken together, they can amplify side effects such as jitters, headaches, rapid heartbeat, insomnia, and restlessness. Some cold medicines already contain caffeine, increasing these risks. Studies also show that combining caffeine and pseudoephedrine can raise blood sugar and body temperature, which is especially important for people with diabetes. Similar concerns exist for ADHD medications like amphetamines and asthma drugs such as theophylline, which share chemical similarities with caffeine. 2. Thyroid medication Levothyroxine, used for underactive thyroid, is sensitive to timing. Drinking coffee too soon after taking it can reduce absorption by up to 50%. Caffeine speeds up digestion, giving the drug less time to be absorbed, and may bind to it in the stomach. This means less medication reaches the bloodstream, potentially causing hypothyroid symptoms like fatigue and weight gain to return. The same caution applies to osteoporosis drugs like alendronate and risedronate, which need to be taken on an empty stomach, with a 30-60 minute wait before eating or drinking. 3. Antidepressants and antipsychotics Caffeine's interaction with mental health medications can be complex. SSRIs (like sertraline and citalopram) may have reduced absorption due to caffeine binding in the stomach. Older antidepressants, tricyclic antidepressants (TCAs) such as amitriptyline, are broken down by the same liver enzyme that processes caffeine (CYP1A2). This can slow drug metabolism, increasing side effects or prolonging caffeine's effects, leading to jitteriness. Clozapine, an antipsychotic metabolized by CYP1A2, can have its blood levels nearly doubled by drinking 2-3 cups of coffee, raising risks of drowsiness, confusion, or serious complications. 4. Painkillers Some over-the-counter painkillers contain caffeine to speed absorption and enhance effectiveness. Coffee can make the stomach more acidic and empty faster, helping drugs like aspirin absorb quicker. While this might help relieve pain sooner, it can also increase side effects like stomach irritation or bleeding, especially combined with other caffeine sources. Although serious cases are rare, caution is advised. 5. Heart medications Caffeine can temporarily raise blood pressure and heart rate for a few hours after consumption. For people on blood pressure medications or drugs for irregular heart rhythms, caffeine might reduce their effectiveness. This doesn't mean heart patients must avoid coffee entirely, but they should monitor their symptoms and consider limiting caffeine or switching to decaf if needed. How to stay safe Coffee is more than just a comforting ritual; it's a powerful chemical that can affect how your medicines work. To avoid problems: Take levothyroxine or bisphosphonates with water on an empty stomach, and wait 30-60 minutes before drinking coffee or eating.n Be careful when using cold remedies, asthma drugs, or ADHD medications with caffeine, as side effects can increase.n Talk to your doctor if you take antidepressants, antipsychotics, or heart medications about your caffeine intake.n Consider cutting back or switching to decaf if you experience jitters, insomnia, or palpitations.n Everyone metabolizes caffeine differently, so pay attention to how you feel and consult your healthcare provider if you notice issues.n When in doubt, ask your pharmacist or doctor whether your medicine and coffee make a safe pair. A quick chat can help you avoid side effects and enjoy your coffee worry-free.
BBC News
25-06-2025
- Health
- BBC News
Llandudno mental health patient's death partly due to neglect
Neglect contributed to the death of a man in a mental health unit, an inquest jury has Roberts-Pomeroy, 24, was found dead in his bed at the Tŷ Llewelyn unit in Bryn y Neuadd Hospital in Llanfairfechan, Conwy county, on 1 October complained of stomach aches the day before and was due to have medical checks every four hours during the night, but they did not happen and security nurse Geraint Jones, who claimed to have visually checked on him hourly, was found to have given "dishonest" a narrative conclusion contributed to by neglect, the Ruthin inquest jury recorded "gross absence of care" after Roberts-Pomeroy's death from sepsis. Roberts-Pomeroy, from Llandudno, was jailed for three years and four months for robbery in July 2018, but was transferred to Tŷ Llywelyn under the Mental Health was treated for schizophrenia and was being prescribed Clozapine, a "gold standard" treatment but known side effects include constipation. A pathologist found Roberts-Pomeroy died of sepsis caused by a toxic megacolon as a result of Clozapine-induced Brian Rogers, who carried out the post-mortem examination said he may have been dead for up to six hours before he was found at 09: first started complaining of stomach aches at lunchtime the day before his Laura Robbins said, when she checked about 13:00, she was not overly concerned about constipation because he had a bowel movement the previous night. Nurse Jayne Bayliss and ward manager James Butterworth did medical checks at 19:50, but a faulty blood pressure machine meant they were not meant Roberts-Pomeroy's care should have been escalated and screened for sepsis, but it was not. Checks were repeated at 21:00 by overnight ward manager Claire Leady and security nurse Geraint Jones said in a statement that Roberts-Pomeroy was asleep at 22:00 and he claimed to have done hourly visual Coroner John Gittins said CCTV footage proved this to be "untrue", adding that the health board had "taken action" and Mr Jones no longer worked there. Expert witness Abhiram Sharma said if Roberts-Pomeroy had been monitored as he should and treatment provided, he would probably have jury concluded staff failings included "an obvious failure to provide basic medical attention for Darren, insufficient monitoring... simple basic medical checks not carried out and inadequate communication of staff duties and responsibilities".Roberts-Pomeroy's father Peter Pomeroy said his son was improving at the hospital and "felt happy" there, adding that he was "astounded" to know his son was not checked a statement, the family said: "We finally feel as though we can start to move on having had some sort of closure for Darren's tragic and devastating passing."Teresa Owen of the health board said: "We fully accept the jury's conclusions and will reflect further on them over the coming days."She added that an independent investigation highlighted a number of recommendations that had been "accepted and actioned".
The Guardian
22-05-2025
- Health
- The Guardian
Bondi Junction inquest told most people with treatment-resistant schizophrenia relapse without medication
About 90% of people who have treatment-resistant schizophrenia and discontinue their antipsychotic medication relapse after two years, a coronial inquest has heard amid a probe into the mental health and care of Joel Cauchi. The inquest, scheduled for five weeks, is examining the fatal stabbing of six people by Cauchi at Westfield Bondi Junction in April 2024. Cauchi, then 40, killed Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, and injured 10 others at the shopping centre on 13 April last year before he was shot and killed by police officer Amy Scott. At the time, Cauchi was not medicated for his schizophrenia, the coroners court has heard. He had been weaned off medication by a psychiatrist and was meant to be monitored, but wasn't. On Thursday, the inquest heard from a panel of psychiatrists who provided expert opinions on the care and treatment of Cauchi. The court heard that Clozapine – which can have severe side effects – was generally considered a life-long medication for people with treatment-resistant schizophrenia due to a high relapse rate of 77% after one year and 90% after two years for those who stopped taking it. Psychiatrist Prof Olav Nielssen told the court that homicide of strangers by people with schizophrenia was rare, with one occurring in New South Wales about every two years. He said a 'feature of that small group' was having gone off medication and homelessness. Cauchi was unmedicated and homeless at the time of the Bondi Junction stabbings. Prof Merete Nordentoft, a psychiatrist in Denmark, told the Sydney court: 'Most people with schizophrenia will never commit an act of serious violence, but a disproportionate number of homicides are committed by people with psychotic illness.' Those who do harm others, Nordentoft said, usually had delusions including thinking they were 'being followed and somebody is trying to harm you, and therefore you need to protect yourself'. Sign up to Morning Mail Our Australian morning briefing breaks down the key stories of the day, telling you what's happening and why it matters after newsletter promotion She said in Copenhagen there were clinics that supported patients who wanted to come off anti-psychotic medication. The patients had weekly monitoring for 18 months. But, the psychiatrist told the court, most people found they couldn't completely end their medication. 'The patients actually get a higher level of acceptance that this treatment is needed,' she said, noting the process had a silver lining.
The Advertiser
15-05-2025
- Health
- The Advertiser
'Red flag': warning sign when killer wanted gun licence
The man responsible for the Bondi Junction stabbing attack gave false information about his antipsychotic medications in a bid to get a gun licence years earlier. Joel Cauchi, 40, killed six people and injured 10 others at Sydney's Bondi Junction Westfield in April 2024 before being shot dead by police. In January 2021, he approached a Brisbane psychiatrist seeking medical clearance to get a licence so he could shoot pistols under supervision at a local gun range. The doctor testified at an inquest on Thursday. Cauchi told him he had been on the antipsychotic Clozapine for only two years before coming off it 18 months earlier. However, reports obtained by the doctor from Cauchi's former private psychiatric clinic in Toowoomba revealed he had been on the medication for 16 or 17 years since being diagnosed with schizophrenia as a teen. The psychiatrist, who cannot be legally identified, admitted under questioning by counsel assisting Emma Sullivan that this was a "red flag". He acknowledged he should not have supplied Cauchi with a medical report. This document deemed him to be a "fit and proper person" to hold a gun licence and was sent to Queensland Police. Police granted Cauchi a certificate of eligibility but he never applied for a gun licence. The psychiatrist said if he had known of prior concerns raised by Cauchi's mother about declines in his mental health, he would have reached out to her to learn more. These potential signs of relapse included a large number of notes being left around the house - some referring to satanic control - excessive obsessive-compulsive disorder, an obsession with pornography, irritability and a strange gait. Records supplied by the Toowoomba psychiatric clinic did not contain this information, despite his mother contacting them repeatedly after his antipsychotic medication was ceased in mid-2019. The Brisbane doctor said he had provided the medical report to police after finding Cauchi a "very low risk to himself and others". The document should have noted he had only seen Cauchi once and was not his regular psychiatrist, he told the court. "In hindsight, I would have done things a lot differently," he said by videolink. A lack of available detail about Cauchi's history was also a theme when his former general practitioner Richard Grundy gave evidence. He testified he was not told of any concerns when Cauchi relocated from Toowoomba to Brisbane in early 2020. Dr Grundy said he would have attempted a follow-up if he had been told about the concerns raised by Cauchi's mother. "I didn't have any information - all those things that were discussed for some reason or another never came to me," Dr Grundy told the court by videolink from London. On discharging Cauchi from her clinic in March 2020, his private psychiatrist sent a letter to Dr Grundy. "Please recall Joel to discuss his options and referral to an alternative psychiatrist if required," she wrote. In earlier evidence given to the coroner, she insisted she had a lengthy phone conversation with Dr Grundy after sending this letter. "I can take Joel back, I am the family GP, I know him very well and I will recall (him)," the GP told her, according to her evidence. But on Thursday, he denied that this conversation took place. By mid-2019, Cauchi was completely off the antipsychotics and he became detached from the mental health system early the following year after moving to Brisbane. The inquest continues on Monday. Lifeline 13 11 14 beyondblue 1300 22 4636 The man responsible for the Bondi Junction stabbing attack gave false information about his antipsychotic medications in a bid to get a gun licence years earlier. Joel Cauchi, 40, killed six people and injured 10 others at Sydney's Bondi Junction Westfield in April 2024 before being shot dead by police. In January 2021, he approached a Brisbane psychiatrist seeking medical clearance to get a licence so he could shoot pistols under supervision at a local gun range. The doctor testified at an inquest on Thursday. Cauchi told him he had been on the antipsychotic Clozapine for only two years before coming off it 18 months earlier. However, reports obtained by the doctor from Cauchi's former private psychiatric clinic in Toowoomba revealed he had been on the medication for 16 or 17 years since being diagnosed with schizophrenia as a teen. The psychiatrist, who cannot be legally identified, admitted under questioning by counsel assisting Emma Sullivan that this was a "red flag". He acknowledged he should not have supplied Cauchi with a medical report. This document deemed him to be a "fit and proper person" to hold a gun licence and was sent to Queensland Police. Police granted Cauchi a certificate of eligibility but he never applied for a gun licence. The psychiatrist said if he had known of prior concerns raised by Cauchi's mother about declines in his mental health, he would have reached out to her to learn more. These potential signs of relapse included a large number of notes being left around the house - some referring to satanic control - excessive obsessive-compulsive disorder, an obsession with pornography, irritability and a strange gait. Records supplied by the Toowoomba psychiatric clinic did not contain this information, despite his mother contacting them repeatedly after his antipsychotic medication was ceased in mid-2019. The Brisbane doctor said he had provided the medical report to police after finding Cauchi a "very low risk to himself and others". The document should have noted he had only seen Cauchi once and was not his regular psychiatrist, he told the court. "In hindsight, I would have done things a lot differently," he said by videolink. A lack of available detail about Cauchi's history was also a theme when his former general practitioner Richard Grundy gave evidence. He testified he was not told of any concerns when Cauchi relocated from Toowoomba to Brisbane in early 2020. Dr Grundy said he would have attempted a follow-up if he had been told about the concerns raised by Cauchi's mother. "I didn't have any information - all those things that were discussed for some reason or another never came to me," Dr Grundy told the court by videolink from London. On discharging Cauchi from her clinic in March 2020, his private psychiatrist sent a letter to Dr Grundy. "Please recall Joel to discuss his options and referral to an alternative psychiatrist if required," she wrote. In earlier evidence given to the coroner, she insisted she had a lengthy phone conversation with Dr Grundy after sending this letter. "I can take Joel back, I am the family GP, I know him very well and I will recall (him)," the GP told her, according to her evidence. But on Thursday, he denied that this conversation took place. By mid-2019, Cauchi was completely off the antipsychotics and he became detached from the mental health system early the following year after moving to Brisbane. The inquest continues on Monday. Lifeline 13 11 14 beyondblue 1300 22 4636 The man responsible for the Bondi Junction stabbing attack gave false information about his antipsychotic medications in a bid to get a gun licence years earlier. Joel Cauchi, 40, killed six people and injured 10 others at Sydney's Bondi Junction Westfield in April 2024 before being shot dead by police. In January 2021, he approached a Brisbane psychiatrist seeking medical clearance to get a licence so he could shoot pistols under supervision at a local gun range. The doctor testified at an inquest on Thursday. Cauchi told him he had been on the antipsychotic Clozapine for only two years before coming off it 18 months earlier. However, reports obtained by the doctor from Cauchi's former private psychiatric clinic in Toowoomba revealed he had been on the medication for 16 or 17 years since being diagnosed with schizophrenia as a teen. The psychiatrist, who cannot be legally identified, admitted under questioning by counsel assisting Emma Sullivan that this was a "red flag". He acknowledged he should not have supplied Cauchi with a medical report. This document deemed him to be a "fit and proper person" to hold a gun licence and was sent to Queensland Police. Police granted Cauchi a certificate of eligibility but he never applied for a gun licence. The psychiatrist said if he had known of prior concerns raised by Cauchi's mother about declines in his mental health, he would have reached out to her to learn more. These potential signs of relapse included a large number of notes being left around the house - some referring to satanic control - excessive obsessive-compulsive disorder, an obsession with pornography, irritability and a strange gait. Records supplied by the Toowoomba psychiatric clinic did not contain this information, despite his mother contacting them repeatedly after his antipsychotic medication was ceased in mid-2019. The Brisbane doctor said he had provided the medical report to police after finding Cauchi a "very low risk to himself and others". The document should have noted he had only seen Cauchi once and was not his regular psychiatrist, he told the court. "In hindsight, I would have done things a lot differently," he said by videolink. A lack of available detail about Cauchi's history was also a theme when his former general practitioner Richard Grundy gave evidence. He testified he was not told of any concerns when Cauchi relocated from Toowoomba to Brisbane in early 2020. Dr Grundy said he would have attempted a follow-up if he had been told about the concerns raised by Cauchi's mother. "I didn't have any information - all those things that were discussed for some reason or another never came to me," Dr Grundy told the court by videolink from London. On discharging Cauchi from her clinic in March 2020, his private psychiatrist sent a letter to Dr Grundy. "Please recall Joel to discuss his options and referral to an alternative psychiatrist if required," she wrote. In earlier evidence given to the coroner, she insisted she had a lengthy phone conversation with Dr Grundy after sending this letter. "I can take Joel back, I am the family GP, I know him very well and I will recall (him)," the GP told her, according to her evidence. But on Thursday, he denied that this conversation took place. By mid-2019, Cauchi was completely off the antipsychotics and he became detached from the mental health system early the following year after moving to Brisbane. The inquest continues on Monday. Lifeline 13 11 14 beyondblue 1300 22 4636 The man responsible for the Bondi Junction stabbing attack gave false information about his antipsychotic medications in a bid to get a gun licence years earlier. Joel Cauchi, 40, killed six people and injured 10 others at Sydney's Bondi Junction Westfield in April 2024 before being shot dead by police. In January 2021, he approached a Brisbane psychiatrist seeking medical clearance to get a licence so he could shoot pistols under supervision at a local gun range. The doctor testified at an inquest on Thursday. Cauchi told him he had been on the antipsychotic Clozapine for only two years before coming off it 18 months earlier. However, reports obtained by the doctor from Cauchi's former private psychiatric clinic in Toowoomba revealed he had been on the medication for 16 or 17 years since being diagnosed with schizophrenia as a teen. The psychiatrist, who cannot be legally identified, admitted under questioning by counsel assisting Emma Sullivan that this was a "red flag". He acknowledged he should not have supplied Cauchi with a medical report. This document deemed him to be a "fit and proper person" to hold a gun licence and was sent to Queensland Police. Police granted Cauchi a certificate of eligibility but he never applied for a gun licence. The psychiatrist said if he had known of prior concerns raised by Cauchi's mother about declines in his mental health, he would have reached out to her to learn more. These potential signs of relapse included a large number of notes being left around the house - some referring to satanic control - excessive obsessive-compulsive disorder, an obsession with pornography, irritability and a strange gait. Records supplied by the Toowoomba psychiatric clinic did not contain this information, despite his mother contacting them repeatedly after his antipsychotic medication was ceased in mid-2019. The Brisbane doctor said he had provided the medical report to police after finding Cauchi a "very low risk to himself and others". The document should have noted he had only seen Cauchi once and was not his regular psychiatrist, he told the court. "In hindsight, I would have done things a lot differently," he said by videolink. A lack of available detail about Cauchi's history was also a theme when his former general practitioner Richard Grundy gave evidence. He testified he was not told of any concerns when Cauchi relocated from Toowoomba to Brisbane in early 2020. Dr Grundy said he would have attempted a follow-up if he had been told about the concerns raised by Cauchi's mother. "I didn't have any information - all those things that were discussed for some reason or another never came to me," Dr Grundy told the court by videolink from London. On discharging Cauchi from her clinic in March 2020, his private psychiatrist sent a letter to Dr Grundy. "Please recall Joel to discuss his options and referral to an alternative psychiatrist if required," she wrote. In earlier evidence given to the coroner, she insisted she had a lengthy phone conversation with Dr Grundy after sending this letter. "I can take Joel back, I am the family GP, I know him very well and I will recall (him)," the GP told her, according to her evidence. But on Thursday, he denied that this conversation took place. By mid-2019, Cauchi was completely off the antipsychotics and he became detached from the mental health system early the following year after moving to Brisbane. The inquest continues on Monday. Lifeline 13 11 14 beyondblue 1300 22 4636
