Loxapine can be an excellent alternative to clozapine.
If the discontinuation of treatment with clozapine is desired, it should be gradually tapered off over several weeks, rather than abruptly discontinued, except in cases of emergency, such as agranulocytosis, and then only with close monitoring of the patient.
Clozapine and olanzapine have the safest therapeutic effect, while the side effect of neutropenia must be controlled by 3 weekly blood controls.
Clozaril (clozapine) and Seroquel (quetiapine) are antipsychotic medications used to treat schizophrenia. Clozaril is also used to help reduce the risk of suicidal behavior in people with schizophrenia or similar disorders. Seroquel is also used to treat major depression and bipolar disorder.
Clozapine is still a good choice in TRS, and it was found to be more effective than quetiapine. However, clozapine was associated with greater side effects than quetiapine.
Undoubtedly the most significant barrier to use of clozapine is the stringent restrictions around blood monitoring. Clozapine was first introduced in the 1970s in Europe, but was withdrawn after the drug was shown to be associated with agranulocytosis—an acute condition involving severe leukopenia.
Clozapine is superior to other antipsychotics as a therapy for treatment-resistant schizophrenia and schizoaffective disorder with increased risk of suicidal behavior. This drug has also been used in the off-label treatment of bipolar disorder, major depressive disorder (MDD), and Parkinson's disease (PD).
No clear differences were observed between clozapine and olanzapine with regard to the incidence of metabolic effects and weight gain, which are some of the side effects olanzapine is closely associated with.
Clozapine has an average rating of 7.6 out of 10 from a total of 67 ratings on Drugs.com. 71% of reviewers reported a positive effect, while 19% reported a negative effect. Risperidone has an average rating of 5.4 out of 10 from a total of 687 ratings on Drugs.com.
Solid evidence suggests that Clozapine is the most effective antipsychotic drug for schizophrenics who do not respond to treatment with first- or second-generation antipsychotics.
Now, a United States-based biotech organisation called Karuna Therapeutics Inc. has developed a new combination drug called KarXT. It is the first potential new pharmacological approach for treating schizophrenia in over 50 years and may provide an alternative option for people living with the condition.
Antipsychotics are often recommended life-long for people diagnosed with schizophrenia or other serious mental illnesses because they are effective at controlling psychotic symptoms in the short term and might reduce the risk of relapse.
However, research has shown that long-term use (7–11 years) of any antipsychotic treatment by people with schizophrenia is associated with lower mortality than no drug use and clozapine is associated with lower mortality than other commonly used first- and second-generation antipsychotic agents.
If you miss 2 or more days of clozapine doses, talk to your doctor before you start taking it again. You might have to restart the medicine at a lower dose than you were taking before.
Permanent discontinuation of clozapine treatment is recommended for patients showing evidence of agranulocytosis, myocarditis, cardiomyopathy, or QT prolongation greater than 500 ms if no alternative causes can be found.
The most severe and potentially life-threatening clozapine-related blood dyscrasias is neutropenia, which may eventually develop into clozapine-induced agranulocytosis or granulocytopenia. This occurs in roughly 0.8–2% of patients and requires mandatory hematological monitoring.
Antipsychotic medications are the most effective treatment for schizophrenia. Medications such as Risperdal and Zyprexa have been shown to reduce both the positive and negative symptoms of schizophrenia by up to 40%.
Clozapine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
Results: Equivalent efficacy of olanzapine to clozapine was found in 90% of the patients (18/20) in the study group, without rehospitalization or suicidal behavior in any of the patients. Also notable was a reduction in drug-induced side effects and improved subjective response to pharmacotherapy.
Olanzapine is used to treat schizophrenia. It may also be used alone or with other medicines (eg, lithium or valproate) to treat mania or mixed episodes that is part of bipolar disorder (manic-depressive illness).
Clozapine has unique and powerful side effects and risks, which often make it a drug of last resort.
When Clozapine Doesn't Work. For TRS, there aren't many well-tested treatments besides clozapine. But if you don't respond well to it, your doctor could try adding electroconvulsive therapy (ECT) to your treatment plan.
Clozapine can also cause problems with your metabolism. This includes high cholesterol, high blood sugar, and weight gain. This may lead to complications, like hypertension, Type 2 diabetes, and obesity. It's important to discuss ways to lower your risk for these long-term problems with your healthcare provider.
So yes, it has been clearly established for many years that “some patients are better off without antipsychotic drugs.” However, in recent years, advocates have interpreted this to suggest that most individuals with schizophrenia are better off without antipsychotic drugs.