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Clozapine is an antopsychotic drug grouped roughly together with other "atypical" or second-generation antipsychotics. Brand names for Clozapine include Clozaril and Versacloz. Clozapine works by binding to several different types of neurotransmitter receptors, and is especially effective as a serotonin antagonist, but attach to only select dopamine receptors ("Clozapine," 2016).
Clozapine is most commonly prescribed for schizophrenia, but can also be prescribed in severe cases of bipolar disorder that include the presence of psychotic mania. The drug may be indicated for persons experiencing hallucinations, and can reduce suicidal tendencies as well as reduce some of the cognitive issues associated with psychosis including disorganized or delusional thinking ("Clozapine," 2016). It is prescribed when other pharmacological interventions fail, and Clozapine is also noted for its ability to reduce the negative symptoms of schizophrenia including mood disorders, uninterested in social activities, and problems communicating -- symptoms that are rarely addressed with either first generation or other atypical antipsychotic medications (McEvoy, et al., 2006).
Side effects of Clozapine can be serious, including metabolic syndrome leading to obesity and other health effects (Lamberti, et al., 2006), blood disorders, diabetes, seizures, myocarditis, and dementia ("Clozapine," 2016;...
Many of the side effects are "life-threatening," leading some psychiatrists to be reluctant to prescribe the drug other than as a last resort (McEvoy, et al., 2006, p. 609). Because the side effects can be so serious and potentially traumatic and life threatening, doctors prescribing Clozapine are required to perform extensive and regular patient monitoring, which could be viewed as an inconvenience by the healthcare team. As a result, Clozapine is under-prescribed in spite of being one of the most effective treatments for psychosis.
Less severe but still dangerous side effects of the drug include dizziness, headache, drowsiness, dry mouth or excessive salivation, and constipation. Other drawbacks include the fact that Clozapine does not help with acute symptoms and the drug must be taken consistently over a long period of time to yield results. The drug may be contraindicated in some patients, depending on preexisting conditions such as hypertension or adverse interactions with other medications.
However, Clozapine is one of the most effective, if not "the most effective" antipsychotic drug in any class (McEvoy, et al., 2006, p. 600). When other antipsychotics, including other atypical antipsychotics, fail to work, Clozapine often proves effective more than any alternative tested (McEvoy et al., 2006). If the patient is not at risk for…
References
"Clozapine," (2016). United States National Library of Medicine. Retrieved online: https://www.nlm.nih.gov/medlineplus/druginfo/meds/a691001.html
Lamberti, et al., (2006). Prevalence of the Metabolic Syndrome Among Patients Receiving Clozapine. American Journal of Psychiatry 163(7): 1273-1276.
McEvoy, J.P. et al. (2006). Effectiveness of Clozapine vs. Olanzapine, Quetiapine, and Risperidone in Patients With Chronic Schizophrenia Who Did Not Respond to Prior Atypical Antipsychotic Treatment. American Journal of Psychiatry 163(4).
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