Methylphenidate as Treatment for Clozapine-Induced Sedation in Patients with Treatment-Resistant Schizophrenia.

Abstract

Treatment-resistant schizophrenia patients frequently need to be managed with clozapine. However, noncompliance is in-part due to complaints of sedation, fatigue, and low energy. There is little literature reporting on the effectiveness and safety of using stimulants to treat clozapine-induced sedation. We report three cases of treatment-resistant schizophrenia where methylphenidate was used to address these common side-effects. To evaluate the effectiveness and safety of psychostimulants in treatment-resistant schizophrenia, we reviewed 3 extensively documented cases of clozapine-induced sedation treated with methylphenidate for over 2 years, in addition to reviewing the literature on this topic. All 3 patients reported improvements in energy and fatigue, along with decreased sedation, while treated with methylphenidate for 27, 30, and 32 months respectively. Clozapine doses ranged between 325mg and 500mg daily; methylphenidate doses ranged between 2.5mg of the immediate-release and 72mg daily of the extended-release formulation. There was no reported or observed increase in psychotic symptoms resulting from treatment with methylphenidate. Methylphenidate may be safe and effective in the management of clozapine-induced sedation in treatment-resistant schizophrenia. Large scale, placebo-controlled, double-blind trials are needed to further validate the safety and efficacy of methylphenidate as treatment for clozapine-induced sedation.