Evidence of pharmacogenetics-based fluvoxamine use as an add-on to clozapine treatment in psychiatry

Author:

Mossé Ulysse1,Chaumette Boris234,Wils Julien56,Imbert Laurent5,Lamoureux Fabien56,Ferrafiat Vladimir78ORCID

Affiliation:

1. Child and Adolescent Psychiatric Unit, L’Unité Régionale d’Hospitalisation Psychiatrique pour Enfants et Adolescents, Centre Hospitalier du Rouvray Sotteville-les Rouen, Rouen, 76000, France

2. Institut National de la Santé et de la Recherche Médicale U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, 75000, France

3. Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, Paris, 75000, France

4. Department of Psychiatry, McGill University, Montreal, H3A 0G4, Canada

5. Department of Pharmacology, Toxicology and Pharmacogenetics, Rouen University Hospital, Rouen, 76000, France

6. Institut National de la Santé et de la Recherche Médicale U1096, Université de Rouen Normandie, Rouen, 76000, France

7. Intensive Care Unit, Department of Child and Adolescent Psychiatry, Marseille-Nord University Hospital, Marseille, 13000, France

8. Reference Center for Inborn Errors of Metabolism, La Timone University Hospital, Assistance Publique – Hopitaux de Marseille, Marseille, 13000, France

Abstract

Pharmacological treatments used for psychiatric disorders, such as clozapine, demonstrate large interindividual variability in terms of possible adverse effects and therapeutic benefit. This variability can be explained by multiple factors, including pharmacogenetic factors. Clozapine efficacy can be impacted by CYP polymorphisms. A growing body of literature on pharmacogenetics suggests the clinical benefit of concomitant use of clozapine and fluvoxamine to improve global pharmacotherapeutic management. This article reviews and discusses available clinical and pharmacological data and limitations of clozapine augmentation with fluvoxamine based on pharmacogenetic rationale and clinical experience. The aim is to provide an updated approach on how to use the pharmacological and pharmacogenetic profile to improve clozapine efficacy and tolerance in severely ill patients.

Publisher

Future Medicine Ltd

Subject

Pharmacology,Genetics,Molecular Medicine

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