The restrictions of use of Clozaril in the U.S. does inhibit use based on the dangerous side effect (besides heart exploding or cardiac arrest or death)of drug-induced leukemia.

Patients are required by law to have weekly blood work done the first entire year they take it, and after one year if the doctor approves and the lab work has not shown dangerous low white blood cell count and, the pharmacy that dispenses the drug approves, then the patient can go to blood draws once a month. Forever.

The pharmacy has to fill out paperwork and apply to be a pharmacy approved to dispenses Clozaril and therefore not many dispense the drug for prescriptions.

Leaving the patient to find a tricky set up:

1. A doctor to actually prescribe the drug

2. A pharmacy that dispenses the drug

3. A blood work lab that will FAX results to the pharmacy which has professionals review the results (are there normal low white blood cell count)

4.The results are then FAXed to the doctor, but it is the lab and pharmacy that are difficult to find.

So, with those restictive laws in place it makes the drug not so easy to work with logistically, and then the side effects are SO bad, that I am doubtful any doctor will ever agree that Clozaril should be first line treatment for Schizophrenia. That's what it's used for and it's one drug that is only used for that, you don't see much 'off-label' use of Clozaril for good reason. (compared to Seroquel for example for insomnia)

The drug is often a doctor's last choice based on all of the others failing efficacy and frankly, Clozaril doesn't work either. Not unless you consider quality of life stuck in a limbo of a drugged up state of mind with dulled senses so that the symptoms of SZ are lessened (dulled) yet the person is still not functioning, (working, living a so-called 'normal' life).

I base all of what I wrote on a 3 year run of my 21 year old using this drug, and if anyone wants to promote its use for efficacy and greatness and use it first-line treatment, go ahead, and I'll show you a few dozen ppl I see just about every day using it, all disabled, most sitting in a stupified state of mind, still battling the demons of mental illness, and not quite all back, so in essence, it's like being trapped in a world no one wants to be in.

I wouldn't call it a miracle, like the doctor who put my daughter on it, and told me to watch the movie Awakenings for a glimpse of what could happen when he started my daughter on it.

He is the one who also told me then, his infamous words that ended up being sickeningly correct:

"Be prepared to never see the girl you once knew again".

Sadly, 3 years later he was right, the only difference is she isn't locked up in an institution like he wanted her to be in--she's 'free' to come and go, in a world in limbo, with me on outings, and it truly is a sad sight to see a once vibrant young woman--like this.

I've not seen one patient on Clozaril truly live a life 100% "back". That's a lot of drug-risk for so little in return.

Death is imminent on that drug, gold standard for a shortened life span.

If psychiatrists already have maxed out to their maximum number of patients (slaves), maybe there is not enough government money for the more expensive NEW chemicals to keep the slaves under control?

If older tranquilizers can be used, will they? Who's paying?
The slaves will still be slaves either way.
were we/they born slaves or made slaves? why does it matter? Today is all we have.

"sane behavior is attributed to reasons (choices), insane behavior to causes (diseases)" T. Szasz

Is there some unspoken rule of journalism where you're only supposed to provide one interpretation for any given study you cover (in case someone takes this the wrong way, I'm not referring to Philip)? I agree that the idea of reconsidering past dangerous drugs as comparatively less dangerous in light of more dangerous than previously thought contemporary drugs is pretty messed up. However, I'd be satisfied if articles like that just bothered to include the other obvious interpretation-- that antipsychotics are not any safer today and that this study suggests they are even more dangerous.

On the plus side, Clozaril's a cheap generic, so even though that take on this study is a sad reminder of psychiatry's general attitude towards schizophrenia (the condition is already associated with a higher mortality rate, so deadly drugs are free game and drugs with non-deadly permanent side effects are better still), at least no ultra-wealthy corporations stand to benefit by promoting it.

Optimistically, if Clozaril or other generics end up becoming the new drug/s of choice for psychosis, then the lack of a corporate agenda might allow psychiatrists to start abandoning the idea of automatic maintenance therapy. My hunch though is that the belief in the importance of maintenance therapy will be carried over with or without the pharmaceutical companies promoting it.

Psychiatrists take a lot of flak for being less legitimate than regular medical practitioners, which in turn seems to inspire a drive to promote their their practices as serious business in need of "equally" serious treatment methods. Sort of like that art history professor who runs a surprisingly strict class in defiance of the reputation the subject has, except in this case the stakes are obviously much higher.

I haven't found the original article yet but your post indicates there was a difference in EARLY DEATHS and the Reuters article indicates that the difference was due to a reduction in suicides.

Drug induced suicide tends to occur in the first few weeks of treatment and if you get past this period the risk decreases considerably. A number of lethal cardiovascular complications such as cardiomegaly on the other hand are cumulative chronic toxicities and Clozapine is notorious for causing cardiovascular toxicities. (It has more black box warnings than any other atypical antipsychotic.)

Without looking at the totality of the information things can get spun inappropriately.

In terms of being most effective. I'd like to see the head to head comparisons. As far as I'm a ware clozapine was the first of a new class of antipsychotics and it was documented from a few patients that enrolled in the clinical trials that it worked in a few people who had been resistent to older antipsychotics that presumuably work by blocking different receptors. Schizophrenia is a heterogenous disease and so it's not surprising that a new class of drug that works via a different mechanism will work in some individuals who are resistent to an different mechanism and visa versa. This of course would not be unexpected for any new class of drug for any illness, e.g. diabetes. This does not mean that clozapine is more effective overall.

I have personally witnessed over a dozen patients make remarkable improvements on this drug. Every one of the them had poor responses to rounds of other medications. It's not effective for everyone; and the side-effects can be quite bad. But for some, it is a great, life-saving medicine.

I suspect the difference in the mortality numbers is due to the fact that only the sickest of the sick receive clozapine in the U.S. They often have other medical problems that compound their health. And while weight gain and metabolic syndrome are real concerns with clozapine, the data suggests that the risk of agranulocytosis is not as great as once feared.

I am the mother of a schizophrenic son who regained his sanity with clozaril, clozapine. I am sorry that others have not had the same result. For years all of us suffered watching him suffering with the disease. He decided he would rather end his life than to go on living in the schizophrenic state, with the useless medicines the doctors had been giving him until then.

When he was put on Clozapine, he did experience an "Awakenings" change in his life. He drives, lives alone, manages all of his affairs himself, and has made straight A's for the second semester in a row. He has his personality back. I hope chronic schizophrenics will be given the option to try it if nothing else has worked for them. It has been THE MIRACLE for him.

Melanie, I forgot to add at my blog where you left this comment--that the doctor told me to watch Awakenings because of how the patients "came back" and then left again. He said to be prepared for that, and that is what happened, she was able to return to school for about 6 months at by 9 months after starting Clozaril it was no longer a miracle drug. 3 years later, she exists in a very small world, and mute, not at school, or any of that stuff.

Best wishes outcome for your son.

Good post, and good notes. I was around, helping ppl receive decent outpt care, when clozaril emerged. a drug rep tried to recruit me to work for sandoz to go into doc offices and help review charts to find likely candidates for clozaril -- they opted for a nurse, so i missed my chance to be a pharma rep. in the meantime, I saw a couple dozen ppl on this med, getting monitored weekly. I remember the weekly white blood cell tests. I believe that part of the emerging perceived benefit of clozaril is that the ppl receiving clozaril were a hand-picked bunch to begin with (my job was going to be to hand-pick them), and then weekly meetings with the psychiatrist. in my public setting, one MD visit every 3 months was the norm unless you were doing badly. Thus, the people on clozaril were getting a much greater level of care. This could acct for the perceived benefit -- not the drug so much as a hand-picked group with increased level of staff involvement. I agree that, as with ALL of these conditions and ALL of these drugs, for some, the drug produces results almost as profound as l-dopa/Awakenings, while other ppl have very bad effects, even without mentioning the 1/100 risk of agranulocytosis (white blood cell level drastically drops, a life-threatening side effect, hence intense monitoring).

I am on clozaril the person at the top talks about his daughter being in an institution. Sounds like they need to lower the meds. Have you ever heard of pyroluria or histadelia? Some things to make sure they check her for is those plus underactive thyroid, sleep study to find out if she goes into all stages of sleep cause if she don't that could be her problem cause lack of true sleep causes schizophrenia problems (MIMIC). Clozaril has helped me however I still think that we need vitamins and a good diet. What causes chemical imbalances sometimes are never checked for they just diagnose people with sz. For instance a high mch on a cbc would show vitamin b difiecency however alot of doctors don't even pay attention to the mch. So Be PROACTIVE Do it for your daughter. She probably needs less meds and more tests and vitamins. God bless you

If I hadn't taken Clozaril, I would be dead now. The drug saved my life, and my sanity. I would rahter live a shortened life happy, than a long life dead inside.