Clozapine is a medication primarily indicated for the treatment of severely ill patients with schizophrenia who have failed to respond adequately to standard antipsychotic treatments[1]. It is also approved for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are considered at chronic risk for suicide based on their clinical history and condition[1]. Additionally, clozapine may be used for the management of ongoing positive symptoms of psychosis, such as auditory hallucinations or delusions, especially when these symptoms persist despite prior treatments[5].
Aside from its approved uses, clozapine is sometimes prescribed for off-label indications, which include:
- Bipolar disorder (particularly in refractory cases)[6]
- Borderline personality disorder[4][6]
- Substance use disorders[4]
- Management of nonadherence to other antipsychotics[4]
- Polydipsia (excessive thirst and water intake) in psychiatric conditions[4]
- Intermittent explosive disorder (IED) and post-traumatic stress disorder (PTSD) in adolescents, based on some clinical findings[8]
Despite its effectiveness, clozapine’s use is limited by its serious side effect profile, most notably the risk of severe neutropenia (a drop in white blood cells), which requires regular blood monitoring[1][5]. Because of these risks, clozapine is generally reserved for cases where other treatments have failed[1][5].
References
- [1] Clozapine: Uses, Interactions, Mechanism of Action | DrugBank Online
- [4] Off-Label Indications for Clozapine – Psychopharmacology Institute
- [5] Clozapine Resources | Emory School of Medicine
- [6] Rediscovering clozapine: Clinically relevant off-label uses | MDedge
- [8] The off-label use of clozapine in adolescents with bipolar disorder …
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