Clozapine: a review of clinical practice guidelines and prescribing trends

Abstract

BackgroundClozapine effectiveness in the treatment of refractory schizophrenia has been sustained by published evidence in the last two decades, despite the introduction of safer options.DiscussionCurrent clinical practice guidelines have strongly recommended the use of clozapine in treatment-resistant schizophrenia, but prescribing trends do not appear to have followed such recommendations. Clozapine is still underutilized especially in patients at risk of suicide. It seems that physicians are hesitant in prescribing clozapine due to concerns about serious adverse effects. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine and have voiced concerns about the underutilization of clozapine especially in patients at risk of suicide.SummaryGuidelines and prescribing patterns reported in various countries worldwide are discussed. Suggestions on how to optimize clozapine utilization have been published but more efforts are needed to properly inform and support prescribers’ practices.

Trends in the prescription of clozapine in a psychiatric hospital: a 5-year observational study

“…10 The association of clozapine use with risks of neutropenia, agranulocytosis, seizures, and myocarditis could explain the reluctance of psychiatrists to prescribe it. 20 Moreover, the need for careful and continuous blood monitoring could also discourage adherence by patients.…”

“…5 Not only is clozapine underused; its prescription is decreasing in some countries, and initiation is delayed. [6][7][8][9][10] The reasons for this reduction range from the life-threating risks of agranulocytosis 11 and myocarditis 12 to highly disturbing hypersialorrhea 13 and constipation.…”

Allergic Cutaneous and Visceral Angioedema Secondary to Clozapine: A Case Report

“…However, it was reintroduced back in 1990 for individuals with schizophrenia who were resistant to typical neuroleptics (Warnez & Alessi-Severini 2014). Generally, clozapine is proven to be superior to other anti-psychotics (Leucht et al 2009) and its role is also found in other psychiatric disorders, possibly mania (Ng et al 2013).…”

“…Generally, clozapine is proven to be superior to other anti-psychotics (Leucht et al 2009) and its role is also found in other psychiatric disorders, possibly mania (Ng et al 2013). Clozapine is well accepted and tolerated in most individuals (Leucht et al 2013), except few adverse reactions which limits its use (McIlwain et al 2011;Warnez & Alessi-Severini 2014). To date, clozapine is the only drug licensed for for the treatment of treatment-resistant schizophrenia (TRS) (Kane & Corell 2016).…”

Esquizofrenia refratária: qualidade de vida e fatores associados

“…Although there is not a single and globally accepted consensus, refractory schizophrenia can be characterized if there is no improvement in the main symptoms of the disease after treatment with two different classes of antipsychotics (at least one atypical), in suitable doses for a given period of time (four to six, or six to eight weeks). (5) Approximately 30% of the patients had the resistant form, and the treatment of choice is the use of the atypical antipsychotic, clozapine. (6) Clozapine is considered a gold standard in the treatment of patients with refractory schizophrenia, and demonstrates a reduction in acute symptoms and the risk of suicide.…”