OBJECTIVE: To review clozapine's position in treatment algorithms for schizophrenia. METHOD: Clozapine's status is reviewed in the context of its initial discovery and unique clinical and (or) pharmacological profile, withdrawal and link with hematologic concerns, reintroduction with monitoring guidelines, prototype for atypicality, positioning in treatment algorithms, and current evidence regarding efficacy, effectiveness, and side effects. RESULTS: The hematologic monitoring implemented with clozapine's reintroduction here in North America has proven successful in preventing clozapine-related deaths secondary to agranulocytosis. While its other side effects are not without concern, present evidence does not link clozapine to increased mortality rates; indeed, it appears better than other antipsychotics in this regard. Moreover, its clinical superiority compared with all other antipsychotics has been confirmed both in efficacy and in effectiveness trials. CONCLUSIONS: Schizophrenia continues to represent a treatment challenge, with many people demonstrating suboptimal response and poor functional outcome. Clozapine is routinely positioned as a third-line treatment in schizophrenia, but in light of existing evidence this warrants re-examination.
OBJECTIVE: To review clozapine's position in treatment algorithms for schizophrenia. METHOD:Clozapine's status is reviewed in the context of its initial discovery and unique clinical and (or) pharmacological profile, withdrawal and link with hematologic concerns, reintroduction with monitoring guidelines, prototype for atypicality, positioning in treatment algorithms, and current evidence regarding efficacy, effectiveness, and side effects. RESULTS: The hematologic monitoring implemented with clozapine's reintroduction here in North America has proven successful in preventing clozapine-related deaths secondary to agranulocytosis. While its other side effects are not without concern, present evidence does not link clozapine to increased mortality rates; indeed, it appears better than other antipsychotics in this regard. Moreover, its clinical superiority compared with all other antipsychotics has been confirmed both in efficacy and in effectiveness trials. CONCLUSIONS:Schizophrenia continues to represent a treatment challenge, with many people demonstrating suboptimal response and poor functional outcome. Clozapine is routinely positioned as a third-line treatment in schizophrenia, but in light of existing evidence this warrants re-examination.
Authors: Gary Remington; Donald Addington; William Honer; Zahinoor Ismail; Thomas Raedler; Michael Teehan Journal: Can J Psychiatry Date: 2017-07-13 Impact factor: 4.356
Authors: Melanie D Guenette; Margaret Hahn; Tony A Cohn; Celine Teo; Gary J Remington Journal: Psychopharmacology (Berl) Date: 2013-01-24 Impact factor: 4.530
Authors: Taixiang Saur; Sarah E DeMarco; Angelica Ortiz; Gregory R Sliwoski; Limin Hao; Xin Wang; Bruce M Cohen; Edgar A Buttner Journal: PLoS Genet Date: 2013-02-28 Impact factor: 5.917