Reasons for discontinuing clozapine: matched, case–control comparison with risperidone long-acting injection

Abstract

Clozapine use in patients with severe mental illness was associated with a significantly increased risk of death compared with that for the general population. Causation could not be established. Adverse effects and death are common causes of clozapine discontinuation.

Aspiration Pneumonia

“…18 Mortality was higher in patients receiving clozapine compared with depot risperidone, and pneumonia was the leading cause of clozapine-associated death. 19 Clozapine alone or combined with other second-generation antipsychotic medications increases pneumonia risk in inpatients with schizophrenia. 20 Other studies found first and second-generation antipsychotic medications increase pneumonia risk, but secondgeneration agents confer greater risk.…”

Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement

“…Reported proportions of patients on clozapine having seizures range from 1.1% to 20%,36–39) and associated fatalities have been reported 9,40). Convulsions are dose related,33) and higher plasma clozapine concentrations have been linked to an increased risk of seizures 41).…”

Behavior Genetics of Psychopathology

“…In addition to its high response rate and unique effi cacy, it possesses anti-suicidal, anti-aggression and anti-substance misuse properties (Farooq & Taylor, 2011 ). However, Clozapine's affi nity for several neurotransmitter receptors (Falkai et al, 2006 ) elicits a wide range and heavy burden of ADRs (Nielsen, Damkier, Lublin, & Taylor, 2011 ) (apart from extrapyramidal side effects which are generally improved (Flanagan, 2008 )), more than other medications (Taylor, Douglas-Hall, Olofi njana, Whiskey, & Thomas, 2009 ), with a substantial percentage of patients (17 % (Young, Bowers, & Mazure, 1998 ) to 35 % (Taylor et al, 2009 )) having to be withdrawn from Clozapine because of severe ADRs including those that can be grouped as haematological, cardiac, neurological/psychiatric and others. As a consequence of the ADRs, guidelines of professional bodies such as the Royal Australian and New Zealand College of Psychiatrists and the US National Institute for Health and Clinical Excellence state that treatment of Clozapine should only be initiated in patients who do not respond adequately to treatment of at least two different antipsychotics including one other second-generation antipsychotic.…”