By Ken Duckworth, M.D.
What makes clozapine a unique and effective antipsychotic? As I detailed in my recent Advocate piece, Clozapine is the only FDA-approved medicine for treatment resistant schizophrenia. It’s been found to be effective in treatment resistant schizophrenia and in reducing the risk of suicide in people who have schizoaffective disorder or schizophrenia. I feel it is underutilized, and have seen many good outcomes on this medication. The one caveat of this medication is that it requires vigilance to monitoring of medical side effects.
A recent announcement by the FDA stated that beginning October 15 it will change the approach to monitoring clozapine. There are two key areas that are being changed, which both strike me as substantial improvements. The changes address a rare but serious side effect of clozapine, which is the reduction of a specific type of white cells called neutrophils. For those taking clozapine, having their blood drawn on a structured schedule monitors their neutrophil counts (the schedule is not changing as a result of these changes). Greatly reduced neutrophil counts can lead to risk of infection or death, which is why monitoring for this risk is incredibly important. This is especially true during the first six months of treatment when the risk is greatest.
Here are the announced changes to monitoring clozapine:
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