Treatment with clozapine decreases overall mortality in schizophrenia, in part by reducing suicidality. 4 Clozapine may also limit substance misuse. 5,6 International guidelines for the treatment of schizophrenia recommend that clozapine be offered after someone fails to respond adequately to trials of at least two other antipsychotics, excluding discontinuations due to side effects. 1 This is because clozapine is no more efficacious than other antipsychotics as a ‘first-line’ treatment for schizophrenia per se and secondly because there is a recognized risk of blood dyscrasias especially in the first 3 months of clozapine treatment. 1,7 Dispensing of clozapine in most countries is dependent on the results of mandatory haematological monitoring, although whether monitoring needs to continue beyond 12 months of successful therapy is the subject of debate. 8
How effective is clozapine for treatment-resistant schizophrenia?
Clozapine has been established to be more beneficial than conventional antipsychotics in patients with treatment-resistant schizophrenia and apparently more useful, based on existing evidence, in managing the negative symptoms of schizophrenia.
Can ECT be used to treat clozapine-resistant schizophrenia?
Clozapine is the gold standard for therapy of treatment-resistant schizophrenia despite causing a plethora of side effects. ECT is being used increasingly in schizophrenia as a promising augmentation strategy with clozapine in clozapine-resistant schizophrenia.
How does clozapine treat catatonia?
Clozapine is not used extensively but appears to be unique among antipsychotics in that it improves the symptoms of catatonia rather than causing or worsening them.
How many patients were taking clozapine?
It was unclear how many patients were taking clozapine. In the two case reports where myocarditis occurred, titration of clozapine was faster than 12.5 mg to 25 mg per day. No other information is provided regarding these case reports.
Why is clozapine not first line treatment?
In summary, it is difficult to make a case for clozapine as a first-line treatment. As noted, there is a high response rate in the first-episode population regardless of the choice of antipsychotic.
Why is it not considered a first line treatment for schizophrenia?
There is no clear antipsychotic drug of choice for schizophrenia. Clozapine is the most effective medication but is not recommended as first-line therapy because it has a high burden of adverse effects, requires regular blood work, and has not outperformed other medications in first-episode patients.
Is clozapine first line for schizophrenia?
Clozapine is not authorized for use in first line treatment for schizophrenia. Clozapine is FDA-indicated for treatment-resistant schizophrenia and suicide prevention in patients with schizophrenia or schizoaffective disorder with chronic suicidal behaviors.
Why is clozapine not more commonly used?
In general in the United States the use of clozapine is restricted to those people with schizophrenia who have failed first-line treatments. The reason for this restriction is its risk of severe side effects.
Why is clozapine second line?
As a first‐ or second‐line treatment option clozapine outperforms other antipsychotics in schizophrenia spectrum disorders. Compared to first‐line risperidone, clozapine is more effective in schizophrenia spectrum disorders.
What is the first-line treatment for schizophrenia?
Antipsychotic medications are the first-line medication treatment for schizophrenia. They have been shown in clinical trials to be effective in treating symptoms and behaviors associated with the disorder. However, antipsychotic medications have significant side effects.
Is clozapine a first generation antipsychotic?
Clozapine is a medication that works in the brain to treat schizophrenia. It is also known as a second generation antipsychotic (SGA) or atypical antipsychotic. Clozapine rebalances dopamine and serotonin to improve thinking, mood, and behavior.
Why is clozapine used in resistant schizophrenia?
Clozapine can facilitate improvement in social function of patients with treatment-resistant schizophrenia; particularly when combined with appropriate support from clinicians who can facilitate finding and keeping jobs or return to school [67, 68]. It has been reported to be effective for treating disorganization.
Is clozapine effective for schizophrenia?
Clozapine is effective for treating positive symptoms in approximately two-thirds of the 30% of patients with schizophrenia whose psychosis is minimally responsive to typical or atypical antipsy- chotic drugs at ordinary doses.
Why is clozapine controversial?
Historically, clozapine was distinguished by one of its dangerous and sometimes lethal side effects, agranulocytosis, which almost caused its complete banishment from the psychiatric pharmacopoeia.
Why is clozapine better than other antipsychotics?
Clozapine differs from conventional antipsychotics for its greater efficacy in controlling positive symptoms in people with treatment-resistant illness and by inducing few extra-pyramidal effects (Kane 1988, Wahlbeck 1999).
Is clozapine the most effective antipsychotic?
With respect to the incidence of discontinuation, clozapine was the most effective antipsychotic drug, followed by aripiprazole. As with the survival analysis for time to discontinuation, clozapine and aripiprazole were the top ranked.