Clozapine use has been notably lower in African American patients than in Caucasians due to many potential reasons such as prescribing disparities and adherence issues. It has been suggested that lower normal ranges for white blood cell (WBC) counts in African-Americans, known as benign ethnic neutropenia, may account partially for the disparity.
Smoking is a common method of self medication in the severely mentally ill population. This population continues to smoke despite health risks associated with smoking. Statistics show that these persons die about 25 years earlier than the general population and could benefit greatly from smoking cessation.
Clozapine is the most effective antipsychotic and is recommended for treatment-refractory schizophrenic patients. Despite its efficacy, clozapine should be reserved for patients who have failed to respond to others standard medications because of potential fatal side effects such as agranulocytosis. Therapeutic monitoring of clozapine, consisting in complete blood count and plasma concentrations of clozapine (PCC), is helpful to prevent toxicities and to assure efficacy. However, there are no well-defined guidelines for the monitoring of PCC. In the literature, therapeutic targets of PCC provide data on response to treatment but not on remission time. A good proxy for remission is the absence of rehospitalization. The aim of this retrospective and longitudinal study is to verify the relationship between PCC and patient rehospitalization.
Myocarditis, inflammation of the myocardium, is a potential side effect of clozapine, occurring in approximately 0.015-0.188% of patients. Clozapine-induced myocarditis (CIM) is underreported due to the symptom similarities with clozapine dose escalations. When left untreated, myocarditis has a high fatality rate.
The second generation antipsychotic agents, also called atypical antipsychotics, are generally well tolerated but are known to cause metabolic disturbances such as weight gain, dyslipidemia, and hyperglycemia. Clozapine is most often associated with these metabolic side effects. Patients taking clozapine are required to have blood drawn every 1, 2, or 4 weeks, depending on length of treatment, to monitor for agranulocytosis. Given the frequency of lab work, clozapine patients and their physicians should have the highest likelihood of metabolic monitoring compliance.
Clozapine’s proven effectiveness in treatment-refractory schizophrenia makes it a valuable medication. However, clozapine carries a black box warning pertaining to its seizure-inducing properties.