Abstract
Introduction: The clinical records of 190 patients with schizophrenia who discontinued clozapine
between 1990 and 2012 in the county of Northamptonshire were examined, in an attempt
to answer the following questions. Why do patients stop clozapine? What do physicians
prescribe as an alternative? What is the mortality in this patient group?
Methods: Patients’ data were extracted using their electronic records, then analysed using
descriptive statistical methods.
Results: Non-compliance with treatment, or with the mandatory white blood cell monitoring,
was the most common reason (55.3%) for clozapine cessation, followed by neutropaenia
and other adverse effects (25.2%). Death (mean age 48 years) was the third most common
reason (10%), with respiratory infections accounting for more than a quarter of the
deaths. 13% of the patients had died (mean age 49 years) at some point following clozapine
discontinuation. In terms of the alternative antipsychotic prescribing, olanzapine
was the most commonly prescribed (37.1%) drug in patients who were still under the
care of the local psychiatric service (n=121), at the time of data extraction. Clozapine
had been reinstated in 19% of these patients.
Discussion: Our findings are generally consistent with previous studies, and they demonstrate
the need for physicians to address their patients’ concerns regarding clozapine treatment,
and to effectively manage any adverse effects. Sialorrhea and constipation seem to
be particularly of concern, as they may be linked to clozapine– related mortality.
Olanzapine was the most commonly prescribed alternative to clozapine, which suggests
that it may possibly have a role in refractory schizophrenia.
Key words
schizophrenia past clozapine - clozapine discontinuation - clozapine mortality - alternative
to clozapine - olanzapine
