Introduction clozapine

Clozapine (Clozaril). Clozapine was introduced over 30 years ago but has only been available in the United States since 1990. It remains the medication of choice for treatment-resistant schizophrenia. Since its introduction, it has been used to treat acute mania with excellent results. Furthermore, it avoids the potential for tardive dyskinesia posed by haloperidol and the other typical antipsychotics. 

A wide range of disorders can benefit from antipsychotic therapy. For example, since the introduction of antipsychotics, 25% fewer hospital beds are occupied by patients with schizophrenia. In particular, the newer antipsychotics hold the promise of benefitting patients once refractory to conventional treatment. Thus, negative, cognitive, and mood symptoms may improve with use of newer agents such as clozapine, risperidone, olanzapine, quetiapine, and ziprasidone. 

Early after the introduction of risperidone, many patients who were doing reasonably well on clozapine risked deterioration by abruptly switching to risperidone. 

The introduction of clozapine, risperidone, quetiapine, and ziprazidone has had a dramatic impact on the decision-making process in choosing an antipsychotic. Thus, these agents both minimize neurological adverse effects and may qualitatively improve some psychotic symptoms to a greater degree than neuroleptics. 

Risperidone and olanzapine are more effective than neuroleptics and safer than neuroleptics and clozapine, so they represent first-line choices. Quetiapine and ziprasidone are safer but may only be equal in efficacy to neuroleptics. The timing for clozapine is less certain with arguments put forth for earlier versus later introduction based on efficacy and safety issues, respectively. Clozapine is an important drug for the patients who have not fully remitted with first line drugs. 

Over 10 000 patients have been treated with clozapine in Australia since its introduction in 1993, and the Clozaril monitoring system has ensured that since that time there have been no deaths from agranulocytosis in patients taking clozapine (155). 

Raised clozapine blood concentrations have been reported after the introduction of lisinopril (294). 

A fatal case of neuroleptic malignant syndrome which started to develop two days after the introduction of clozapine 25 mg daily to established treatment with paroxetine 20 mg daily has been reported. The patient had previously taken clozapine alone with no problem. ... 

Introduction - Although several promising agents have progressed to advanced clinical stages, no fundamentally new antipsychotic or antianxiety agents were Introduced in the U.S. In 1973. Clozapine has emerged as the focus of clinical and theoretical Interest In the antipsychotic area based on Its extremely low Incidence of extrapyramldal side reactions. 

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