A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia

Treatment-resistant schizophrenia (TRS) will affect about one in three patients with schizophrenia. Clozapine is the only treatment approved for TRS, and patients should be treated as soon as possible to improve their chances of achieving remission. Despite its effectiveness, concern over side effec...

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Bibliographic Details
Published in:CNS drugs 2022-07, Vol.36 (7), p.659-679
Main Authors: Correll, C. U., Agid, Ofer, Crespo-Facorro, Benedicto, de Bartolomeis, Andrea, Fagiolini, Andrea, Seppälä, Niko, Howes, Oliver D.
Format: Article
Language:English
Subjects:
Algorithms
Antipsychotic Agents - adverse effects
Antipsychotics
Check lists
Checklist
Clozapine
Clozapine - adverse effects
Contraindications
Dopamine
Drug dosages
FDA approval
Humans
Medicine
Medicine & Public Health
Mental disorders
Meta-analysis
Metabolism
Mortality
Neurology
Neurosciences
Older people
Patients
Pediatrics
Pharmacotherapy
Pregnancy
Psychiatry
Psychopharmacology
Psychosis
Psychotropic drugs
Remission
Schizophrenia
Schizophrenia - drug therapy
Schizophrenia, Treatment-Resistant
Suicides & suicide attempts
Systematic review
Therapy in Practice
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Summary:Treatment-resistant schizophrenia (TRS) will affect about one in three patients with schizophrenia. Clozapine is the only treatment approved for TRS, and patients should be treated as soon as possible to improve their chances of achieving remission. Despite its effectiveness, concern over side effects, monitoring requirements, and inexperience with prescribing often result in long delays that can expose patients to unnecessary risks and compromise their chances of achieving favorable long-term outcomes. We critically reviewed the literature on clozapine use in TRS, focusing on guidelines, systematic reviews, and algorithms to identify strategies for improving clozapine safety and tolerability. Based on this, we have provided an overview of strategies to support early initiation of clozapine in patients with TRS based on the latest evidence and our clinical experience, and have summarized the key elements in a practical, evidence-based checklist for identifying and managing patients with TRS, with the aim of increasing confidence in prescribing and monitoring clozapine therapy.
ISSN:1172-7047
1179-1934
DOI:10.1007/s40263-022-00932-2