Skip to content
naulon
Get started

No retraction, correction or concern found when last checked on Oct 22, 2026.

Clozapine: a review of clinical practice guidelines and prescribing trends

Stephanie Warnez, Silvia Alessi-Severini

BMC Psychiatry · 2014 · Review

doi:10.1186/1471-244x-14-102

Abstract

Background. Clozapine effectiveness in the treatment of refractory schizophrenia has been sustained by published evidence in the last two decades, despite the introduction of safer options.

Discussion. Current clinical practice guidelines have strongly recommended the use of clozapine in treatment-resistant schizophrenia, but prescribing trends do not appear to have followed such recommendations. Clozapine is still underutilized especially in patients at risk of suicide. It seems that physicians are hesitant in prescribing clozapine due to concerns about serious adverse effects. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine and have voiced concerns about the underutilization of clozapine especially in patients at risk of suicide.

Summary. Guidelines and prescribing patterns reported in various countries worldwide are discussed. Suggestions on how to optimize clozapine utilization have been published but more efforts are needed to properly inform and support prescribers’ practices.

Full text

From PubMed Central, U.S. National Library of Medicine, as current on Oct 22, 2026. Paragraph numbers are ours, so an answer can point at one.

Background

Clozapine efficacy as an “atypical” antipsychotic agent has been recognized since the early 1960s. This agent became available on the European market for the treatment of schizophrenia with the promise of a better tolerability because of the absence of those extrapyramidal side effects that afflicted patients treated with other antipsychotic agents (e.g., chlorpromazine and haloperidol, now defined as “typical” or first- generation agents, FGAs). However, the release of alarming reports of agranulocytosis in Finnish patients created panic among prescribers; a total of 17 cases were confirmed among 100 patients treated with clozapine, 8 of those cases resulted in fatalities. Clozapine was immediately withdrawn from the market by Sandoz (1976).

It was not until fourteen years after its withdrawal that the results of the pivotal US Clozaril Study were published and the important role of clozapine in clinical practice was discovered. Clozapine demonstrated superiority to chlorpromazine in treatment-resistant patients in many outcomes including treatment response, with improvements in positive and negative symptoms of schizophrenia. This led health agencies to grant clozapine access to the US and Canadian markets in 1990 and 1991, respectively.

The recognized risk for agranulocytosis, assessed at a prevalence of 1-2%, has been managed since then by mandatory monitoring systems administered by the manufacturers of the clozapine products (now generized in most countries) to assure that patients undergo routine blood testing before each dispensation. Current product monographs mandate that patients start therapy gradually and that normal WBC and absolute neutrophil counts (ANC) are maintained at safe levels (WBC count ≥3500/mm3 and ANC ≥2000/mm3) throughout treatment. Thus, patients at risk of developing agranulocytosis can be identified before the condition becomes life-threatening. The implementation of registries for the monitoring of hematological toxicity has in fact significantly reduced mortality and morbidity in patients treated with clozapine.

The 1990s saw also the introduction of other new “atypical” antipsychotics (e.g., risperidone, olanzapine, quetiapine also identified as second-generation agents, SGAs). These agents, developed to obtain efficacious medications similar to clozapine without the hematological toxicity, generated hope for improved compliance and Quality of Life (QoL) in patients affected by schizophrenia. Early studies of SGAs demonstrated superiority over the FGAs, including a lower incidence of EPS, superior efficacy for positive, negative and mood symptoms, improved tolerability, as well as cognitive enhancing effects. Despite higher costs, SGAs were widely adopted worldwide. However, none of the newer SGAs could demonstrate superiority to clozapine and in the last decade many published clinical practice guidelines have recommended that clozapine be prescribed to patients with treatment-resistant schizophrenia, which has been defined as not responsive to two trials of any other antipsychotic medication (either FGA or SGA). Despite such recommendations and the overwhelming evidence of clozapine effectiveness, prescribing of clozapine appears to be low, delayed and often preceded by attempts at polypharmacy treatment, which lacks clinical evidence of effectiveness.

Aim and scope

The main objectives of this article are to provide information on clozapine place in therapy and to discuss clozapine’s prescribing trends since the publication of the most recent schizophrenia clinical practice guidelines in North America and Europe.

Methods

Clinical practice guidelines, meta-analyses, and reports on clozapine prescribing trends have been identified from searches in PubMed, Psychinfo, EMBASE and Cochrane databases. The search was focused on publications in the last 10-year period (2004 and 2014). Articles selection was limited to those written in the English language. Individual clinical trials and older landmark studies have been cited where appropriate. Keywords used in the literature search included: clozapine, prescribing, schizophrenia, antipsychotic(s), utilization, guidelines.

Clozapine vs. FGAs

Clozapine effectiveness was initially demonstrated against chlorpromazine, the prototype of the FGAs. Evidence of clozapine advantage over FGAs has been well established and results of various trials, conducted mostly in the 1990s, have been included in meta-analyses. The conclusions were that clozapine was more effective than FGAs in reducing symptoms of schizophrenia according to measurements of BPRS scores and SANS negative symptoms scores. Clozapine produced clinically meaningful improvements and postponed relapse.

Clozapine vs. SGAs

The landmark study CUtLASS 2 found that in patients failing to respond to two or more antipsychotics, clozapine produced significant improvement in symptoms over 1 year. The phase 2E CATIE study revealed that clozapine was significantly more effective than quetiapine and risperidone, and the authors concluded that in patients with an insufficient therapeutic response to a SGA, clozapine was more effective than switching to a different SGA.

More recent evidence has confirmed clozapine superiority to other SGAs and olanzapine.

Clozapine effectiveness on mortality

Effects of clozapine treatment on patient mortality has been assessed and reviewed over the years in various populations. The evidence supports a clear advantage of clozapine therapy in terms of reduced mortality over other antipsychotic agents including FGAs, risperidone and quetiapine.

Clinical practice guidelines and algorithms

The evidence produced in the last 20 years, and summarized by published clinical practice guidelines and algorithms, has confirmed clozapine to be the gold standard for treatment-resistant schizophrenia. Please refer to Table 1 for a summary of recommendations.

Clozapine prescribing trends

Treatment-resistant schizophrenia has been established to affect 20-30% of all patients diagnosed with schizophrenia. Nevertheless, physicians’ prescribing practices reveal that only a small portion of patients with treatment-resistant schizophrenia are treated with clozapine. In 1999, only 160,000 US patients of the 2.6 million diagnosed with schizophrenia were treated with clozapine (only 25% of treatment-resistant patients). Since the introduction of the newer SGAs, clozapine use decreased in the United States: in 1999, clozapine represented 11% out of the total SGAs prescribed, which steadily decreased to less than 5% in 2002. During phase 3 of the CATIE study, 51% of patients had previously discontinued medications due to ineffective therapeutic response, but only 11% of patients were offered clozapine during phase 3. Studies of clozapine utilization have shown that adherence to guidelines has been poor through the years with clozapine been consistently underutilized in the US, UK, Canada, New Zealand and Australia. In a study of the Veterans Health Administration, only 2% of patients affected by schizophrenia were receiving clozapine.

Adherence to treatment guidelines in the UK was also very poor in terms of clozapine initiation as in more than 34% of patients’ polypharmacy and high dose treatments were used before commencing clozapine.

Recent Canadian statistics, based on physician drug recommendations from 2005 to 2009, show a 48% increase in clozapine recommendations over a 5-year period; however, a more recent report determined that 68% of an outpatient population had tried 3 or more antipsychotics before switching to clozapine. In contrast, clozapine utilization in Australia appears to be more appropriate with a percentage as high as 51% of clozapine use in treatment-resistance schizophrenia.

Discussion

Despite the long and still ongoing debate about the comparative safety and effectiveness of FGAs and SGAs, during the last two decades, clozapine has maintained its place in therapy as the treatment of choice in refractory schizophrenia (third-line agent). It has also been suggested that earlier use (as a second line agent) can be recommended in individuals with persistent hostility/aggressive behaviour and suicidalilty. In fact the indication for recurrent suicidal behavior has been officially approved by the FDA. Its role in first-episode and non-treatment-resistant patients has been investigated and while further research in the area of early onset schizophrenia and time to treatment response is needed, clozapine value as a second line agent has been recently recognized in a first-episode schizophrenia population.

While clinical practice guidelines have strongly endorsed clozapine as the gold standard of therapy, its use has been lower that recommended. Reasons for physicians’ reluctance to prescribe clozapine have been evaluated and the relatively high incidence of agranulocytosis has certainly had great influence; however, the careful monitoring of WBC counts and ANC has almost completely abolished the risk of fatal agranulocytosis; frequency of blood tests has recently been simplified and once WBC counts and ANCs have been maintained within normal levels for one year, blood tests are now only required once every 4 weeks. It is also of importance to note that in some European countries a more flexible monitoring schedule, which can be reduced to quarterly blood testing in individuals not at risk, has been proposed.

Concerns over other adverse effects, which include weight gain, hyperglycemia, seizures, tachycardia, myocarditis and neuromalignant syndrome, can affect the decision making process and even less severe side effects (sedation, constipation, nocturnal hypersalivation) might result in patients’ resistance to try this medication. Clozapine has shown, however, a definite advantage in reversing tardive dyskinesia. Suggestions on how to balance safety and effectiveness of clozapine have been given. Other issues can be seen in the added costs associated with blood monitoring and health care system contacts due to the need for gradual titration of clozapine therapy, however, clozapine cost-effectiveness has been consistently shown over other agents. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine and have voiced concern that clozapine is still under utilized especially in patients at risk of suicide. Interprofessional practice models that see pharmacists being more involved in patient care have been advocated to improve and optimize prescribing of clozapine.

Summary

• Published clinical evidence has supported clozapine as the gold standard in the treatment of refractory schizophrenia as it is reflected in the recommendations of many clinical practice guidelines.

• Clinical practice guidelines, however, do not appear to have been followed by prescribers and clozapine remains an underutilized medication in patients with treatment-resistant schizophrenia.

• Efforts are needed to encourage and optimize clozapine utilization.

Abbreviations

AA: Antipsychotic agent; ANC: Absolute neutrophil count; APA: American Psychiatric Association; BAP: British Association for Psychopharmacology; BPRS: Brief Psychiatric Rating Scale; CADTH: Canadian Agency for Drugs and Technologies in Health; CPA: Canadian Psychiatry Association; CATIE: Clinical Antipsychotic Trials of Intervention Effectiveness; CUtLASS: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study; EPS: Extrapyramidal Symptoms; FDA: Food and Drug Administration; FGAs: First Generation Antipsychotics; NICE: National Institute of Health and Clinical Excellence; PAP: Psychopharmacology Algorithm Project; PORT: Patient Outcomes Research Team; QoL: Quality of Life; SANS: Scale for the Assessment of Negative Symptoms; SGAs: Second Generation Antipsychotics; TD: Tardive dyskinesia; TMAP: Texas Medication Algorithm Project; WBC: White blood cells.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

SW conducted the bibliographic research and drafted the article. SAS designed and supervised the project, and wrote the final draft. Both authors read and approved the final manuscript.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-244X/14/102/prepub

References 70

  1. 1.

    Crilly J The history of clozapine and its emergence in the US market: a review and analysisHist Psychiatry2007 1813960

    Not in our library10.1177/0957154x07070335

  2. 2.

    Kane J Honigfeld G Singer J Meltzer H Clozapine for the treatment-resistant schizophrenic, A double-blind comparison with chlorpromazineArch Gen Psychiatry1988 459789796

    Not in our library10.1001/archpsyc.1988.01800330013001

  3. 3.

    ClozarilProduct MonographHealth Canada http://webprod5.hc-sc.gc.ca/dpd-bdpp/info.do?code=11421&lang=eng Accessed on January 30, 2014

    Not in our library

  4. 4.

    Honigfeld G Arellano F Sethi J Bianchini A Schein J Reducing clozapine-related morbidity and mortality: 5 years of experience with the Clozaril National RegistryJ Clin Psychiatry1998 59Suppl 337

    Not in our library

  5. 5.

    Hartling L Abou-Setta A Dursum S Mousavi SS Pasichnyk D Newton AS Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medicationsAnn Int Med2012 157498511

    Not in our library10.7326/0003-4819-157-7-201210020-00525

  6. 6.

    Leucht S Cipriani A Spinelli L Mavridis D Orey D Richter F Samara M Barbui C Engel RR Geddes JR Kissling W Stapf MP Lässig B Salanti G Davis JM Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple treatments meta-analysisLancet2013 382951962

    Not in our library10.1016/s0140-6736(13)60733-3

  7. 7.

    Leucht S Pitschel-Walz G Abraham D Kissling W Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo: a meta-analysis of randomized controlled trialsSchizoph Res1999 355168

    Not in our library10.1016/s0920-9964(98)00105-4

  8. 8.

    Correll CU Leucht S Kane JM Lower risk for tardive dyskinesia associated with sec- ond-generation antipsychotics: a systematic review of 1-year studiesAm J Psychiatry2004 161414425

    Not in our library10.1176/appi.ajp.161.3.414

  9. 9.

    Alessi-Severini S Biscontri R Collins D Kozyrskyj A Sareen J Enns M Utilization and Costs of Antipsychotic Agents: a Canadian Population-Based Study: 1996–2006Psychiatr Serv2008 595547553

    Not in our library10.1176/appi.ps.59.5.547

  10. 10.

    Pringsheim T Lam D Tano DS Patten SB The pharmacoepidemiology of antipsychotics for adults with schizophrenia in Canada, 2005 to 2009Can J Psychiatry2011 5610630634

    Not in our library10.1177/070674371105601009

  11. 11.

    Aparasu RR Bhatara V Gupta S US national trends in the use of antipsychotics during office visits, 1998–2002Ann Clin Psychiatry2005 17147152

    Not in our library10.1080/10401230591002084

  12. 12.

    Trifirò G Spina E Brignoli O Sessa E Caputi AP Mazzaglia G Antipsychotic prescribing pattern among Italian general practitioners: a population- based study during the years 1999–2002Eur J Clin Pharmacol2005 614753

    Not in our library10.1007/s00228-004-0868-3

  13. 13.

    Lehman AF Lieberman JA Dixon LB McGlashan TH Miller AL Perkins DO Kreyenbuhl J American Psychiatric Association; Steering Committee on Practice GuidelinesPractice guideline for the treatment of patients with schizophrenia, second editionAm J Psychiatry2004 1612156

    Not in our library

  14. 14.

    Addington D Bouchard RH Goldberg J Honer B Malla A Norman R Tempier R Berzins S Clinical practice guidelines: treatment of schizophreniaCan J Psychiatry2005 50Suppl. 17S57S

    Not in our library

  15. 15.

    Moore TA Buchanan RW Buckley PF Chiles JA Conley RR Crismon ML Essock SM Finnerty M Marder SR Miller DD McEvoy JP Robinson DG Schooler NR Shon SP Stroup TS Miller AL The Texas Medication Algorithm Project: antipsychotic algorithm for schizophrenia: 2006 updateJ Clin Psychiatry2007 6817511762

    Not in our library10.4088/jcp.v68n1115

  16. 16.

    National Institute of Health and Clinical Excellence: Core intervention in the treatment and management of schizophrenia in primary and secondary care (CG82)2009 http://publications.nice.org.uk/schizophrenia-cg82 Accessed January 30, 2014

    Not in our library

  17. 17.

    Buchanan RW Kreyenbuhl J Kelly DL Noel JM Boggs DL Fischer BA Himelhoch S Fang B Peterson E Aquino PR Keller W Schizophrenia Patient Outcomes Research Team (PORT)The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statementsSchizophr Bull2010 3617193

    Not in our library10.1093/schbul/sbp116

  18. 18.

    Clozapine Treatment of Hospitalized Patients: A Review of Clinical Practice Guidelines and SafetyReport December 20, 2010 Accessed on August 10, 2012 http://www.cadth.ca/en/search?q=Clozapine+treatment+in+hospitalized

    Not in our library

  19. 19.

    Barnes TRE Schizophrenia consensus group of the British Association for PsychopharmacologyEvidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for PsychopharmacologyJ Psychopharmacol2011 255567620

    Not in our library10.1177/0269881110391123

  20. 20.

    Osser DN Roudsari MJ Manschreck T The psychopharmacology algorithm project at the Harvard South Shore Program: an update on schizophreniaHarv Rev Psychiatry2013 2111840

    Not in our library10.1097/hrp.0b013e31827fd915

  21. 21.

    Moore TA Covell NH Essock SM Miller AL Real-world antipsychotic treatment practicesPsychiatr Clin North Am2007 303401416

    Not in our library10.1016/j.psc.2007.04.008

  22. 22.

    Taylor DM Young C Paton C Prior antipsychotic prescribing in patients currently receiving clozapine: a case note reviewJ Clin Psychiatry2003 643034

    Not in our library10.4088/jcp.v64n0107

  23. 23.

    Wheeler AJ Treatment pathway and patterns of clozapine prescribing for schizophrenia in New ZealandAnn Pharmacother2008 42852860

    Not in our library10.1345/aph.1k662

  24. 24.

    Joober R Boksa P Clozapine: a distinct, poorly understood and underused moleculeJ Psychiatry Neurosci2010 353147159

    Not in our library10.1503/jpn.100055

  25. 25.

    Howes OD Vergunst F Gee S McGuire P Kapur S Taylor D Adherence to treatment to guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiationBJP2012 201481485

    Not in our library10.1192/bjp.bp.111.105833

  26. 26.
    Clozapine prescribing in a Canadian outpatient population. · 2013
    Not checked
  27. 27.

    Breier A Buchanan RW Kirkpatrick B Davis OR Irish D Summerfelt A Carpenter WT Jr Effect of clozapine on positive and negative symptoms in outpatients with schizophreniaAm J Psychiatry1994 1512026

    Not in our library10.1176/ajp.151.1.20

  28. 28.

    Essock SM Hargreaves WA Covell NH Goethe J Clozapine’s effectiveness for patients in state hospitals: results from a randomized trialPsychopharmacol Bull1996 32683697

    Not in our library

  29. 29.

    Rosenheck R Cramer J Xu W Thomas J Henderson W Frisman L Fye C Charney D Comparison of clozapine and haloperidol in hospitalized patients with refractory schizophreniaN Engl J Med1997 337809815

    Not in our library10.1056/nejm199709183371202

  30. 30.

    Chakos M Lieberman JA Hoffman E Bradford D Sheitman B Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trialsAm J Psychiatry2001 158518526

    Not in our library10.1176/appi.ajp.158.4.518

  31. 31.

    Leucht S Corves C Arbter D Engel RR Li C Davis JM Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysisLancet2009 37396573141

    Not in our library10.1016/s0140-6736(08)61764-x

  32. 32.

    Essali A Al-Haj HN Li C Rathbone J Clozapine versus typical neuroleptic medications for schizophreniaCochrane Database Syst Rev2010 201CD000059pub2

    Not in our library10.1002/14651858.cd000059.pub2

  33. 33.

    Lewis SW Barnes TR Davies L Murray RM Dunn G Hayhurst KP Markwick A Lloyd H Jones PB Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophreniaSchizophr Bull2006 324715723

    Not in our library10.1093/schbul/sbj067

  34. 34.

    Lieberman JA Stroup S McEvoy JP Swartz MS Rosenheck RA Perkins DO Keefe RS Davis SM Davis CE Lebowitz BD Severe J Hsiao JK Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) InvestigatorsEffectiveness of antipsychotic drugs in patients with chronic schizophreniaN Engl J Med2005 35312091223

    Not in our library10.1056/nejmoa051688

  35. 35.

    Stroup TS Lieberman JA McEvoy JP Davis SM Swartz MS Keefe RS Miller AL Rosenheck RA Hsiao JK CATIE InvestigatorsResults of phase 3 of the CATIE schizophrenia trialSchizophr Res2009 1071112

    Not in our library10.1016/j.schres.2008.10.011

  36. 36.

    McEvoy JP Lieberman JA Stroup TS Davis SM Meltzer HY Rosenheck RA Swartz MS Perkins DO Keefe RS Davis CE Severe J Hsiao JK CATIE InvestigatorsEffectiveness of clozapine versus olanzapine, quetipine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatmentAm J Psychiatry2006 163600610

    Not in our library10.1176/appi.ajp.163.4.600

  37. 37.

    Asenjo Lobos C Komossa K Rummel-Kluge C Hunger H Schmid F Schwarz S Leucht S Clozapine versus other atypical antipsychotics for schizophreniaCochrane Database Syst Rev2010 11CD006633

    Not in our library10.1002/14651858.cd006633.pub2

  38. 38.

    Souza JS Kayo M Tassel I Martins CB Elkis H Efficacy of olanzapine in comparison with clozapine for treatment-resistant schizophrenia: evidence from systematic review and meta-analysesCNS Spectrums2013 1828289

    Not in our library10.1017/s1092852912000806

  39. 39.

    Duggan A Wagner J Knapp M Kerwin R Modelling the impact of clozapine on suicide in patients with treatment-resistant schizophreniaBJP2003 182505508

    Not in our library10.1192/bjp.182.6.505

  40. 40.

    Tiihonen J Lönnqvist J Wahlbeck K Klaukka T Niskanen L Tanskanen A Haukka J 11-year follow up of mortality in patients with schizophrenia: a population-based cohort study (FIN 11 study)Lancet2009 374620627

    Not in our library10.1016/s0140-6736(09)60742-x

  41. 41.

    Kasckow J Felmet K Zisook S Managing suicide risk in patients with schizophreniaCNS Drugs2011 252129143

    Not in our library10.2165/11586450-000000000-00000

  42. 42.

    Wasserman D Rihmer Z Rujescu D Sarchiapone M Sokolowski M Titelman D Zalsman G Zemishlany Z Carli V European Psychiatric AssociationThe European Psychiatric Association (EPA) guidance on suicide treatment and preventionEur Psychiatry2012 27129141

    Not in our library10.1016/j.eurpsy.2011.06.003

  43. 43.

    Conley RB Kelly DL Lambert TJ Love RC Comparison of clozapine use in Maryland and in Victoria, AustraliaPsychiatr Serv2005 56320323

    Not in our library10.1176/appi.ps.56.3.320

  44. 44.

    Goren JL Meterko M Williams S Young GJ Baker E Chou CH Kilbourne AM Bauer MS Antipsychotic prescribing pathways, polypharmacy, and clozapine use in treatment of schizophreniaPsychiatr Serv2013 646527533

    Not in our library10.1176/appi.ps.002022012

  45. 45.

    Latimer E Wynant W Clark R Malla A Moodie E Tamblyn R Naidu A Underprescribing of clozapine and unexplained variations in use across hospitals and regions in the Canadian province of QuebecClin Schizophr Relat Psychoses2013 713341

    Not in our library10.3371/csrp.lawy.012513

  46. 46.

    Malalagama G Bastiampillai T Dhillon R Clozapine use in AustraliaAustralas Psychiatry2011 192175

    Not in our library10.3109/10398562.2010.525646

  47. 47.

    Frogley C Taylor D Dickens G Picchioni M A systematic review of the evidence of clozapine’s anti-aggressive effectsInt J Neuropsychopharmacol2012 1513511371

    Not in our library10.1017/s146114571100201x

  48. 48.

    “Clozaril” Prescribing information http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019758s069s071lbl.pdf Accessed January 30, 2014

    Not in our library

  49. 49.

    Woerner MG Robinson DG Alvir JM Sheitman BB Lieberman JA Kane JM Clozapine as a first treatment for schizophreniaAm J Psychiatry2003 160815141526

    Not in our library10.1176/appi.ajp.160.8.1514

  50. 50.

    Lieberman JA Phillips M Gu H Stroup S Zhang P Kong L Ji Z Koch G Hamer RM Atypical and conventional antipsychotic drugs in treatment-naïve first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazineNeuropsychopharmacology2003 2859951003

    Not in our library10.1038/sj.npp.1300157

  51. 51.

    Agid O Remington G Kapur S Arenovich T Zipursky RB Early use of clozapine for poorly responding first-episode psychosisJ Clin Psychopharmacol2007 274369373

    Not in our library10.1097/jcp.0b013e3180d0a6d4

  52. 52.

    Swartz MS Perkins DO Stroup TS Davis SM Capuano G Rosenheck RA Reimherr F McGee MF Keefe RS McEvoy JP Hsiao JK Lieberman JA CATIE InvestigatorsEffects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE studyAm J Psychiatry2007 1643428436

    Not in our library10.1176/appi.ajp.164.3.428

  53. 53.

    Meltzer HY Bobo WV Lee MA Cola P Jayathilake K A randomized trial comparing clozapine and typical neuroleptic drugs in non-treatment-resistant schizophreniaPsychiatry Res2010 1773286293

    Not in our library10.1016/j.psychres.2010.02.018

  54. 54.

    Ascher-Svanum H Nyhuis AW Faries DE Kinon BJ Baker RW Shekhar A Clinical, functional, and economic ramifications of early nonresponse to antipsychotics in the naturalistic treatment of schizophreniaSchizophr Bull2008 34611631171

    Not in our library10.1093/schbul/sbm134

  55. 55.

    Chang YC Lane HY Yang KH Huang CL Optimizing early prediction for antipsychotic response in schizophreniaJ Clin Psychopharmacol2006 266554559

    Not in our library10.1097/01.jcp.0000246211.95905.8c

  56. 56.

    Correll CU Malhotra AK Kaushik S McMeniman M Kane JM Early prediction of antipsychotic response in schizophreniaAm J Psychiatry2003 1601120632065Erratum in: Am J Psychiatry 2005, 162(9):1774

    Not in our library10.1176/appi.ajp.160.11.2063

  57. 57.

    Gallego JA Robinson DG Sevy SM Napolitano B McCormack J Lesser ML Kane JM Time to treatment-response in first –episode schizophrenia: should acute treatment trials last several months?J Clin Psychiatry2011 7216911696

    Not in our library10.4088/jcp.10m06349

  58. 58.

    Agid O Arenovich T Sajeev G Kipursky RB Kapur S Foussias G Remington G An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysisJ Clin Psychiatry2011 721114391444

    Not in our library10.4088/jcp.09m05785yel

  59. 59.

    Netherlands Clozapine Collaboration GroupGuideline for the use of clozapine [English version]2009 [Cited 14 July 2010] http://clozapinepluswerkgroep.nl/pdf/SKMBT_C45110040808460.pdf

    Not in our library

  60. 60.

    Schulte PF Cohen D Bogers JPAM van Dijk D Bakker B A Dutch guideline for the use of clozapineAust N Z J Psychiatry2010 4410551056

    Not in our library10.3109/00048674.2010.514859

  61. 61.

    Van-Kammen DP Marder SR Kaplan HI, Sadock BJSerotonin/dopamine antagonistsComprehensive Textbook of Psychiatry2000 7Baltimore, Md: Lippincott Williams & Wilkins24552473

    Not in our library

  62. 62.

    Hermes E Resenheck Choice of randomization to clozapine versus other second-generation antipsycotics in the CATIE schizophrenia trialJ Psychopharmacol2012 2611941200

    Not in our library10.1177/0269881112443744

  63. 63.

    Meltzer HY Clozapine: balancing safety with superior antipsychotic efficacyClin Schizophr Relat Psychoses2012 63134144

    Not in our library10.3371/csrp.6.3.5

  64. 64.

    Phanthunane P Vos T Whitefors H Bertram M Cost-effectiveness of pharmacological and psychosocial interventions for schizophreniaCost Eff Resour Alloc2011 96doi:10.1186/1478-7547-9-6

    Not in our library10.1186/1478-7547-9-6

  65. 65.

    Attard A Taylor DM Comparative Effectiveness of Atypical Antipsychotics in SchizophreniaCNS Drugs2012 266491508

    Not in our library10.2165/11632020-000000000-00000

  66. 66.

    Sinyor M Remington G Is psychiatry ignoring suicide?J Clin Psychopharmacol2012 323307308

    Not in our library10.1097/jcp.0b013e31825501fb

  67. 67.

    Hill M Freudenreich O Clozapine: key discussion points for prescribersClin Schizophr Relat Psychoses2013 64177185

    Not in our library10.3371/csrp.hifr.01062013

  68. 68.

    Damkier NJ Taylor LH Optimizing clozapine treatmentActa Psychiatric Scand2011 123411422

    Not in our library10.1111/j.1600-0447.2011.01710.x

  69. 69.

    Beck K Howes O Optimising treatment of refractory schizophreniaPsychopharmacology2013 227373374

    Not in our library10.1007/s00213-013-3076-y

  70. 70.

    Williams T Purvis TL Development of an outpatient pharmacist-managed clozapine clinicAm J Health-Syst Pharm2012 6911921195

    Not in our library10.2146/ajhp110461

Cited by papers we hold 2

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.