Clozapine: Medical Uses, Interactions and Side Effects

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Series: Pharmacology – Research, Safety Testing and Regulation
BISAC: MED071000

Even though clozapine is the only drug with evidence-based efficacy in schizophrenia symptoms not responding to other agents, it is still under-prescribed in most countries around the world. The barriers for initiating clozapine are evident in both clinicians and patients. Prescribers mainly report delaying clozapine because of fear of severe side effects and lack of knowledge regarding management of side effects driven by stigmatic rather evidence-based views. Patients report reservations toward the need for safety regulation and blood tests.

Enduring psychotic illness is often associated with high level of burden of symptoms, which does not allow progress into recovery process in the community. It is often the case that treatment with clozapine has a dramatic effect on symptoms, otherwise refractory. However, there cases in which there is only minor or no effect of the drug. In these cases, sometimes referred to as ultra-resistant schizophrenia, it is advised to optimise clozapine treatment using pharmacokinetic considerations and confirm sufficient clozapine serum levels using therapeutic drug monitoring. Further steps include precise diagnosis and management of other physical or psychiatric comorbidities, offering targeted psychotherapy such as CBT and family interventions and eventually to wait, as sometimes there are cases of late response.

In this book we aimed at providing clinicians with practical, up-do-date knowledge to support their decision-making and safety management when prescribing clozapine. It is our hope that using the information in this book would encourage both prescribers and patients to consider clozapine treatment when it is needed, in a timely fashion. We believe that accurate and systematic information is a key for reducing anxiety and relieving stigma associated with clozapine treatment.
(Imprint: Nova Medicine and Health)

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Table of Contents

Table of Contents

Preface

Introduction

Chapter 1. History of Clozapine
(Chanoch Miodownik, MD, Alexander Grinshpoon, MD, MHA, PhD, and Vladimir Lerner, MD, PhD, Division of Psychiatry, Ministry of Health Be’er Sheva Mental Health Center, Faculty of Health Sciences Ben-Gurion University of the Negev, Be’er Sheva, Israel, and others)

Chapter 2. Clozapine: Pharmacokinetics and Pharmacodynamics
(Amir Krivoy, MD, and Abraham Weizman, MD, Geha Mental Health Center, Petach-Tikva, Israel, and others)

Chapter 3. Clozapine Treatment for Negative Signs and Cognitive Impairment in Schizophrenia
(Kfir Feffer, MD, and Inna Levin, MD, Lev-HaSharon Mental Health Center, Tzur-Moshe and Tel-Aviv University, Tel-Aviv, Israel)

Chapter 4. Side Effects and Safety Considerations
(Nuwan Galappathie, and Angela Shaw, St Andrew’s Healthcare, Birmingham, UK)

Chapter 5. Clozapine-Resistant Schizophrenia Management: Combination and Augmentation Strategies and Interactions
(Chanoch Miodownik, MD, and Vladimir Lerner, MD, PhD, Division of Psychiatry, Ministry of Health Be’er Sheva Mental Health Center, Faculty of Health Sciences Ben-Gurion University of the Negev, Be’er Sheva, Israel)

Chapter 6. Clozapine Off-Label Uses
(Pavlo Papach, MD, and Anatoly Kreinin, MD, PhD, Maale Carmel Mental Health Center, Affiliated to Bruce Rappaport Medical Faculty, Technion, Haifa, Israel)

Chapter 7. Monitoring Clozapine (Regulations and Recommendations Worldwide)
(Anna Khavkina, MD, and Anatoly Kreinin, MD, PhD, Maale Carmel Mental Health Center, Affiliated to Bruce Rappaport Medical Faculty, Technion, Haifa, Israel)

Chapter 8. Clozapine in Children and Adolescents
(Moshe Lachish, MD and Helene Sher, MD, Division of Psychiatry, Ministry of Health Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel, and others)

Chapter 9. Clozapine: Frequently Practical Clinical Asked Questions and Possible Answers
(Amir Krivoy, MD, Vladimir Lerner, MD, PhD, and Chanoch Miodownik, MD, Geha Mental Health Center, Petach-Tikva, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv, Israel)

Audience

This book is written for psychiatrists and GP

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