Purpose/Background: Clozapine-induced hypersalivation is one of the most common bothersome adverse reactions of clozapine. The management strategies for this condition remain inadequately studied and understood. The objective of the study is to compare the effectiveness and tolerability of (1) trihexyphenidyl 5 mg/d, (2) clonidine 0.15 mg/d, or (3) a reduction of clozapine dosage by 25 to 50 mg/d for managing clozapine-induced hypersalivation Methods/Procedures: A randomized, open-label, non–placebo-controlled clinical trial was conducted from December 2023 to May 2024. Eligible patients were randomly assigned to 1 of 3 groups. Primary outcomes were assessed using the Drooling Severity and Frequency Scale (DSFS) and the Nocturnal Hypersalivation Rating Scale (NHRS) at baseline, week 4, and week 8. Quality of life assessed using the pharmaceutical therapy for quality of life short version and adverse drug reactions were recorded as secondary outcomes. Findings/Results: A total of 67 patients were randomly assigned to 1 of 3 treatment groups. By week 8, significant reductions in DSFS and NHRS scores were observed in all groups, with clonidine showing the greatest improvement. Trihexyphenidyl was also effective, whereas reducing clozapine dose resulted in more modest improvements. Quality of life improved significantly across all groups, with the greatest improvement observed in the clonidine group. The most common adverse effects were dry mouth, constipation, drowsiness, and dizziness. Implications/Conclusions: Clonidine and trihexyphenidyl appear to be more effective options for managing clozapine-induced hypersalivation compared to clozapine dose reduction.

Valproic acid (VPA) is a commonly used anti-seizure medication, owing to its efficacy and cost-effectiveness. However, maintaining appropriate serum levels is crucial due to the narrow therapeutic window, as subtherapeutic levels can lead to treatment failure or adverse outcomes. This study aimed to identify the factors associated with subtherapeutic serum levels of valproic acid in patients undergoing treatment. This retrospective cohort study was performed at a tertiary care hospital and involved inpatients aged ≥ 18 years who were receiving valproic acid for epilepsy treatment. Data were obtained through chart reviews and a Therapeutic Drug Monitoring database. Subtherapeutic VPA levels were defined as < 50 mg/L. Logistic regression was used to identify risk factors for subtherapeutic levels. Of the 152 patients, 96 (63.2%) had subtherapeutic VPA levels (<50 mg/L). Males were more likely than females to have subtherapeutic levels (OR 2.45, 95% CI: 1.15–5.22; P = .02). Previous use of phenytoin significantly increased the risk of subtherapeutic VPA levels (OR 2.58, 95% CI: 1.16–5.71; P = .02). VPA administration by syrup and doses below 15 mg/kg/day were associated with subtherapeutic levels (OR 3.28 and 2.34, respectively). Additionally, co-medications, such as topiramate and meropenem, also increased this risk (OR 5.09 and 4.64, respectively). This study identified several factors significantly associated with subtherapeutic levels of valproic acid, including males, prior phenytoin use, co-medications, such as topiramate and meropenem, and lower VPA dosages. These findings underscore the importance of careful monitoring and individualized treatment plans to maintain therapeutic VPA levels in clinical practice. Further research is needed to explore the clinical implications and to develop strategies to minimize the risk of subtherapeutic levels in patients receiving VPA.

To evaluate the effects of different management strategies (watchful waiting, dose reduction, switching and adjunctive treatments) on prolactin levels and clinical outcomes in patients with antipsychotic-induced hyperprolactinaemia. A prospective cohort study was conducted with 135 adult patients diagnosed with hyperprolactinaemia due to antipsychotic use. Patients were assigned to four management groups: watchful waiting, dose reduction, switching and adjunctive treatment (with aripiprazole). Prolactin levels and clinical symptoms (e.g. galactorrhea, gynaecomastia, menstrual irregularities) were assessed before and after intervention. Baseline prolactin levels were comparable across groups. Post-intervention, all groups exhibited significant reductions in prolactin levels, with the largest decrease observed in the switching and adjunctive treatment group (mean change: -68.3 and -67.1 ng/mL, respectively). Clinical outcomes also improved, with a notable reduction in galactorrhea (p = 0.04), gynaecomastia (p = 0.004) and menstrual irregularities across all groups (p = 0.02). No significant changes were observed in sexual dysfunction, hirsutism or acne. Management strategies for antipsychotic-induced hyperprolactinaemia, particularly switching or adjunctive treatments, effectively reduce prolactin levels and improve related symptoms.

Background: Risperidone is an atypical antipsychotic commonly used in the treatment of schizophrenia. Despite its effectiveness, several adverse drug reactions can be bothersome to patients. Objective: This study aimed to examine the prevalence and characteristics of adverse effects in outpatients with schizophrenia treated with low (<4 mg/day) and standard (≥4 mg/day) doses of risperidone. Method: A cross-sectional study was conducted with 64 patients at a tertiary psychiatric hospital. Data on adverse effects were collected through a self-report questionnaire, and causality was assessed using Naranjo’s Algorithm. Descriptive statistics and chi-square tests were employed for data analysis. Results: The participants comprised 51.56% females, with a mean age of 45.16±14.32 years. Significant gender differences were observed between dose groups, with more females in the low-- dose group (63.16%) than in the standard-dose group (34.62%) (P = 0.02). A total of 221 adverse effects were confirmed after assessment. The most common effects were weight gain (57.81%), increased appetite (48.44%), and dystonia (32.81%). Weight gain was more prevalent in the low-- dose group (68.42%) than the standard-dose group (42.31%; Cohen's h = 0.53, 95% CI: 2.0%–50.2%), while insomnia was higher in the standard-dose group (23.08%) compared to the low-dose group (5.26%; Cohen's h = 0.54, 95% CI: 0.1%–35.5%). Other ADRs, such as dystonia and gastrointestinal symptoms, showed no significant differences between groups. Conclusion: Weight gain was the most prevalent adverse effect associated with risperidone use, particularly at lower doses, while insomnia was more frequent at standard doses, emphasizing the need for careful monitoring and personalized dose adjustments to optimize patient safety. Future studies with larger, longitudinal cohort designs are warranted to confirm these findings and evaluate long-term safety outcomes.

Introduction: E-cigarettes are increasingly popular among university students, raising significant public health concerns. This study aimed to assess the prevalence of e-cigarette use, as well as knowledge, and attitudes toward e-cigarettes among health and non-health science undergraduate...

Dolutegravir (DTG) is widely used in antiretroviral therapy (ART) for its high efficacy and favorable tolerability. However, emerging evidence has raised concerns regarding weight gain and potential metabolic consequences associated with DTG use, with limited longitudinal data from Asian populations. This study aimed to evaluate longitudinal weight changes among people living with HIV (PLWH) receiving DTG‐containing regimens and to determine whether weight trajectories differ across key demographic and clinical subgroups. We conducted a retrospective cohort study of adult PLWH who initiated DTG‐based ART at a tertiary referral center between January 2020 and June 2022, with follow‐up through June 2024. Participants with complete weight data at baseline, 6, 12, 18, and 24 months were included. Weight trajectories were analyzed using repeated‐measures ANCOVA, adjusting for sex, age group, ART backbone (TDF‐based vs. non–TDF‐based), baseline body mass index (BMI), baseline weight, and baseline CD4 cell count. A total of 157 participants (59.2% male; mean age 50.4 years) were included. Mean body weight increased significantly over 24 months in both sexes. Greater numerical weight gain was observed among participants aged ≥ 50 years and those receiving non–TDF‐based regimens. However, only ART backbone demonstrated a significant time‐by‐subgroup interaction. Participants with baseline CD4 counts < 200 cells/mm ³ and lower baseline BMI demonstrated numerically greater weight increases over time. No significant time‐by‐sex, time‐by‐age, time‐by‐BMI, or time‐by‐CD4 interactions were observed, indicating broadly similar longitudinal trajectories across these subgroups after adjustment. DTG‐containing ART was associated with modest but significant weight gain over 24 months in this Thai cohort. ART backbone, differences between TDF‐based and non–TDF‐based regimens, was the primary factor associated with differential weight trajectories. These findings support monitoring of routine weight and metabolic parameters and highlight the importance of individualized ART selection to optimize long‐term metabolic health.