Clozapine could save the lives of suicidal schizophrenic people who aren’t responding to other treatments. So why are so few doctors using it?
’Clozapine has been around since 1959 and is the most effective medication for patients with treatment-resistant schizophrenia. Multiple guidelines say that if a person hasn’t responded to any two antipsychotic drugs, or can’t tolerate their side effects, clozapine should be prescribed. These criteria apply to more than 30 percent of people with schizophrenia in the U.S. and yet, clozapine is actually prescribed to only about 4 percent of them.
Clozapine’s dramatic under-use can be explained, in part, by a rare side effect that led to a cluster of deaths in 1975. Now, the FDA requires stringent monitoring of anyone who takes the drug, which is sold as a generic and under the brand name Clozaril. Patients must join an online registry, and submit to weekly mandatory blood testing. As a result, doctors don’t feel comfortable using it, except as a drug of “last resort.”
But clozapine advocates say that clinicians are too cautious of its rare potential harms, and that we’ve developed a “clozaphobia,” missing out on the drug’s benefits. Clozapine is twice as effective as other antipsychotics available for treatment-resistant schizophrenia and the only drug approved by the FDA to treat suicidal behaviors in people with the disorder. While these experts acknowledge that clozapine’s side effects exist, they think the risks are more than manageable, and that limiting access is a disservice to patients.…’