The efficacy and safety of clozapine therapy for the community-based management of psychotic disorders

Abstract

Background and aims:

Clozapine is the established antipsychotic for patients refractive to, or intolerant to, other antipsychotics. Despite its unfavorable safety profile requiring continued clinical and haematological monitoring, clozapine is tolerated relatively well due to the low risk of associated extrapyramidal effects. Our objective was to assess the safety and efficacy associated with the initiation and continued monitoring of clozapine therapy for the treatment of psychotic disorders in the community.

Methods:

A retrospective single-centre study of patients on clozapine therapy (n=45) for the treatment of psychotic disorders managed within the community between 01/07/05 and 30/06/06. Parameters evaluated included pre-therapy clinical/laboratory evaluation, pre-clozapine antipsychotic medication history, clozapine treatment dosage and duration, initial/late adverse effects, reasons for treatment cessation and psychiatric readmission rate.

Results:

The mean age of our patient cohort was 42.2 years. There was a male predominance with a male:female ratio of 2.5:1. Patients were treated with an average of 3.5 different antipsychotic regimens prior to clozapine commencement. 97.8% of patients commenced clozapine due to treatment resistance. The most common early side-effect was sinus tachycardia (24.4%) followed by hypersalivation (15.6%), whilst weight gain (8.9%) was the most common late onset side-effect. There was 2.2% psychiatric admission rate on clozapine therapy and was due to treatment non-compliance.

Conclusion:

Clozapine is a very effective atypical antipsychotic for managing patients refractive to, or intolerant to, other antipsychotics. Despite its impressive clinical efficacy, clozapine has a significant side-effect profile warranting continued patient vigilance and greater research on its short- and long-term safety.