Managing the adverse effects of clozapine

by Dr James MacCabe and Dr Jennifer Brook


Last updated: April 2019


Clozapine was the first 'atypical' antipsychotic, notable for its unique effectiveness in refractory cases of schizophrenia as well as the absence of extra pyramidal side-effects and tardive dyskinesia (Tandon, 2011). For some time its use was limited by serious adverse effects, including agranulocytosis, but improved monitoring has led to its reintroduction for treatment-resistant schizophrenia. In fact, clozapine has been shown to reduce mortality compared to other antipsychotics (Wimberley et al, 2017).


Clozapine is currently recommended in NICE guidelines (2009) for use in schizophrenia where two previous antipsychotics have been ineffective (treatment-resistant), which occurs in around 30% of patients. Clozapine improves outcomes in around 50–60% of these patients (Meltzer, 1997). Despite this, concerns over adverse effects may cause a premature withdrawal of this highly effective treatment, or a delay in initiation of around four years (Howes et al, 2012).


This module aims to improve understanding of the adverse effects which may arise from clozapine use, increase confidence in alleviating them and suggest management strategies.


Start the module



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