Clozapine: guidelines for clinical management.

The advent of antipsychotic drugs represented a milestone in psychotherapeutics. Despite their proven efficacy, antipsychotic drugs are limited by side effects and treatment resistance in some patients. Since the introduction of chlorpromazine and the subsequent development of numerous neuroleptic compounds, there have been no significant qualitative advances in the clinical efficacy of antipsychotic drugs. Clozapine is an experimental neuroleptic with atypical properties. In clinical testing, this agent has shown superior antipsychotic efficacy in treatment-refractory schizophrenics and a more favorable extrapyramidal side effect profile in comparison with standard neuroleptics. Because clozapine represents a potential contribution to our therapeutic armamentarium, this article provides an overview of its pharmacology, efficacy, and methods of clinical utilization.