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      Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement

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          Abstract

          Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice. It emphasizes the need to broaden the monitoring beyond the mandatory investigations. This may help in improving the safety in clinical practice and increasing clinician confidence for greater and appropriate use of this effective intervention.

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          Termination of clozapine treatment due to medical reasons: when is it warranted and how can it be avoided?

          Jimmi Nielsen, Christoph U. Correll, Peter Manu … (2013)
          To identify the outcome of potentially serious adverse effects of clozapine, particularly those frequently cited as reasons for clozapine discontinuation, and to characterize management strategies for adverse effects that do not warrant discontinuation.
          Article 0 comments Cited 55 times – based on 0 reviews     Review now
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            Psychiatrists' attitude towards and knowledge of clozapine treatment.

            H Lublin, D. Taylor, J. Nielsen … (2010)
            Clozapine is, in most countries, underutilized and the initiation of clozapine is often delayed. The purpose of this study is to investigate the reasons for the delay and the underutilization of clozapine. One hundred psychiatrists were interviewed by phone. The interview was a structured interview with questions regarding attitude to, knowledge of and experiences with clozapine. Forty-eight (48%) psychiatrists had treatment responsibility of fewer than five patients treated with clozapine and 31 of the interviewed psychiatrists (31%) had started clozapine within the last 3 months. Seven psychiatrists (7%) had never prescribed clozapine despite the fact that they had been working more than five years in general psychiatry. Sixty-four psychiatrists (64%) would rather combine two antipsychotics than use clozapine. Sixty-six psychiatrists (66%) believed that patients treated with clozapine were less satisfied with their treatment when compared with those treated with other atypical antipsychotics. Many psychiatrists are reluctant to use clozapine and this might be due to less experience and knowledge of clozapine. A reason for the low awareness of clozapine's properties might be that clozapine is now a generic drug, and therefore, the marketing and education in using the drug is sparse.
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              Comparative Effectiveness of Clozapine and Standard Antipsychotic Treatment in Adults With Schizophrenia.

              T. Stroup, Tobias Gerhard, Stephen Crystal … (2016)
              The authors compared the effectiveness of initiating treatment with either clozapine or a standard antipsychotic among adults with evidence of treatment-resistant schizophrenia in routine clinical practice.
              Article 0 comments Cited 47 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Psychopharmacol Neurosci
                Journal ID (iso-abbrev): Clin Psychopharmacol Neurosci
                Title: Clinical Psychopharmacology and Neuroscience
                Publisher: Korean College of Neuropsychopharmacology
                ISSN (Print): 1738-1088
                ISSN (Electronic): 2093-4327
                Publication date (Print): November 2016
                Publication date (Electronic): 30 November 2016
                Volume: 14
                Issue: 4
                Pages: 323-329
                Affiliations
                [1 ]Black Country Partnership NHS Foundation Trust, Wolverhampton, United Kingdom
                [2 ]North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, United Kingdom
                Author notes
                Address for correspondence: Nilamadhab Kar, MD, DPM, DNB, MRCPsych, Department of Psychiatry, Black Country Partnership NHS, Foundation Trust, The Beeches, Penn Hospital, Penn Road, Wolverhampton, WV4 5HN, UK, Tel: +44-1902-443665, Fax: +44-121-612-3740, E-mail: kar.nilamadhab@ 123456yahoo.com
                Article
                Publisher ID: cpn-14-323
                DOI: 10.9758/cpn.2016.14.4.323
                PMC ID: 5083942
                PubMed ID: 27776383
                SO-VID: ff89f7ea-b3ee-4d9a-a4ea-6737c5e2cf77
                Copyright © Copyright © 2016, Korean College of Neuropsychopharmacology
                License:

                This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 November 2015
                Date revision received : 20 February 2016
                Date accepted : 21 February 2016
                Categories
                Subject: Review

                Keywords: clozapine,adverse effects,drug monitoring,practice guideline,safety
                Data availability:
                Keywords: clozapine, adverse effects, drug monitoring, practice guideline, safety

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