Prescribing Pattern of Clozapine and Clinical Factors associated with Discontinuation of Clozapine

Shi Hyun Kang; Hey Won Lee

doi:10.16946/kjsr.2019.22.1.1

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Kang and Lee: Prescribing Pattern of Clozapine and Clinical Factors associated with Discontinuation of Clozapine

Original Article

Korean Journal of Schizophrenia Research 2019; 22(1): 1-7.

Published online: 25 April 2019

DOI: https://doi.org/10.16946/kjsr.2019.22.1.1

Prescribing Pattern of Clozapine and Clinical Factors associated with Discontinuation of Clozapine

Shi Hyun Kang, MD, PhD, Hey Won Lee, RN

Department of Adult Psychiatry, National Center for Mental Health, Seoul, Korea.

Address for correspondence: Shi Hyun Kang, Department of Adult Psychiatry, National Center for Mental Health, 127 Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea. Tel: 02-2204-0110, Fax: 02-2204-1490, drshe@hanmail.net

Received 23 November 2018 Revised 8 March 2019 Accepted 14 March 2019

Korean Society for Schizophrenia Research

Abstract

Objectives

Clozapine is the drug of choice in treatment-resistant schizophrenia. However, its use is often delayed and a significant proportion of clozapine treated patients fails to respond and experience potentially dangerous side-effects. The aim of this retrospective study was to describe the clinical characteristics of patients started on clozapine and the rate and reason of discontinuation of clozapine.

Methods

Medical records of 83 patients started on clozapine during the period of 2012–2016 were reviewed.

Results

Clozapine started on patients in chronic phase; the mean age of start was 38.1 years old and the mean number of psychiatric admission was 6.5. A majority (80.7%) of the patients had been subjected to antipsychotic polypharmacy prior to clozapine and most (61.5%) of them were being treated with polypharmacy including clozapine. Overall, 39 (47.0%) subjects had continued clozapine whereas 15 (18.1%) discontinued it; 29 (34.9%) were lost to follow-up. The most common reason for discontinuation was side-effects (n=13) including six life-threatening cases, most of which occurred within 6 months of its start.

Conclusion

This study demonstrated that there is some evidence of delays to clozapine use, high rates of polypharmacy and significant rate of discontinuation during the early phase of clozapine treatment.

Keywords: Clozapine, Antipsychotics, Prescribing pattern, Discontinuation, Side effect

Figures and Tables

Table 1

Demographic comparison between clozapine continuation group and discontinuation group

Mean±standard deviations

Table 2

Comparison of concurrent psychiatric medications between clozapine continuation group and discontinuation group

Mean±Standard deviations

Table 3

Side effects causing discontinuation of clozapine

OPD: outpatient department, ADM: admission, CLZ: clozapine, H/O: history of, d: days, m: months, BT: body temperature, WBC: white blood cell, ANC: absolute neutrophil count, LFT: liver function test

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