The effects of zotepine in treating psychotic patients with hyperuricaemia: a case series

Abstract

Zotepine is an atypical antipsychotic which demonstrates a high affinity for dopamine and certain 5-HT receptors and inhibits noradrenaline re-uptake. Clinical trials have shown some evidence of its efficacy against positive and negative symptoms in schizophrenic patients (Petit et al., 1996), and a unique effect on decreasing serum uric acid level was first reported in 1982 (Yoshida et al., 1982). They reported the effect of lowering serum uric acid level and an increased level of uric acid clearance was noted even with only 25 mg/d, and a dose–response effect was also noted. In a randomized, double-blind study comparing zotepine and haloperidol in 126 schizophrenic patients, the effect of uric acid reductions with zotepine was evident without clinical consequence (Petit et al., 1996). Another randomized, single-blind study switching from clozapine to zotepine in schizophrenic patients showed a significant lowering of serum uric acid levels in the zotepine group compared to the clozapine group (baseline mean of serum uric acid level: 6.1 and 6.0 mg/dl; mean change −5.1 and 0.8 mg/dl respectively, p =0.000) (Lin et al., 2003). The hypouricaemic effect has been reported with other antipsychotics, such as zuclopenthixol (Bloch et al., 1992) and chlorprothixene (Shalev et al., 1987). However, the hypouricaemic effect of zotepine for psychotic patients with hyperuricaemia has not been reported. Here we present four cases to demonstrate the remission of gouty arthritis or hyperuricaemia with zotepine treatment. The results suggest that zotepine may be a good choice for psychotic patients with gouty arthritis or hyperuricaemia.