The Pharmaceutical Journal Vol 267 No 7178 p839-846
15 December 2001

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Clozapine should be prescribed earlier

Clozapine, the only effective drug in treatment refractory schizophrenia, needs to be prescribed much earlier than it is at present, according to David Taylor, chief pharmacist, South London and Maudsley NHS Trust. He adds that more antipsychotic drugs than are necessary are being prescribed for patients who eventually are treated with clozapine.

Mr Taylor's comments appear in a report published this week that documents a discussion between health care professionals working in psychiatry who are concerned that clozapine (Clozaril) is not being used optimally in the United Kingdom. The report, "The earlier use of Clozaril: a discussion" was supported by Novartis, manufacturer of clozapine.

In the report, Mr Taylor describes an ongoing study conducted at the Maudsley Hospital that is looking at the prescribing histories of patients currently receiving clozapine. Of the 50 patients studied so far, 56 per cent had previously received antipsychotic polypharmacy. In addition, the average time from the failure of the second drug tried to the introduction of clozapine was 28.5 months.

Mr Taylor points out that clozapine's licence allows it to be used after the failure of two different drugs given for an adequate period. "This effectively means that patients eventually prescribed clozapine need only have received 12 weeks' prior treatment with other antipsychotics," he says.

Also taking part in the discussions, Professor Robert Kerwin, professor of clinical neuropharmacology, Institute of Psychiatry, said that patients should be tried on a primary atypical for three months before starting clozaril. However, if side effects are a consideration or if there is distress because of a lack of efficacy, then clozaril should be started immediately, he said.

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