Wednesday, December 2, 2009
Clozapine for schizophrenia: Life-threatening or life-saving treatment?
Leslie Citrome, MD, MPH, Professor of psychiatry, New York University School of Medicine, New York, NY, Director, Clinical Research and Evaluation Facility, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
Researchers in Finland surprised psychiatrists this year by announcing that clozapine “seems to be associated with a substantially lower mortality than any other antipsychotic.” This finding also surprised the researchers, who expected their 11-year study to link long-term use of second-generation (“atypical”) antipsychotics with increased mortality in patients with schizophrenia. Instead they found longer lives in patients who used antipsychotics (and particularly clozapine), compared with no antipsychotic use.
This study’s findings do not change clozapine’s association with potentially fatal agranulocytosis as well as weight gain, metabolic abnormalities, and other adverse effects. Clozapine also is difficult to administer, and patients must be enrolled in FDA-mandated registries. These obstacles might discourage you from offering clozapine to patients who could benefit from it.
Why bother considering clozapine? Because recent data on decreased mortality, decreased suicidality, and control of aggressive behavior make clozapine a compelling choice for many patients. Careful attention to clozapine’s adverse effect profile is necessary, but you can manage these risks with appropriate monitoring.
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Listen to Dr. Citrome discuss discusses how to determine if clozapine is an appropriate choice for your patient
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