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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Sir,
ReplyDeleteMy daughter is taking Clozapine for the last 12 years after she stopped responding to other anti/psychotics like respirodone etc. Her intital dosage which was 800 mgs per day is gradually reduced to 500mgs perday and she had not got a relapse after that. Previously we have to face 4 relapses. The blood count tests for Agranulocystosis is a pain but i asked many a Psychiatrists in India and they are yet to see ONE SINGLE casualty due to Agranulocystotsis. Infact Clozapine cured of my daughter some of the symptoms associated with TD. I feel due to drug MNCs profit motive and as this drug is OFF Patent, the FDA is coerced to issue this scary directive.Infact blood count reduction happens IN EVERY ANTIPSYCOTIC DRUG AND CLOZAPINE IS MADE TO SUFFER DUE TO PROFIT MOTIVE.