Delay in initiating clozapine therapy in a Sri Lankan setting

Abstract

Introduction Treatment resistance occurs in one third of patients with schizophrenia. The only licensed drug for this is clozapine. Guidelines recommend that clozapine be offered at the earliest opportunity for patients with treatment resistance. Sometimes, delays occur in initiating clozapine. Objectives and aims To study the delay in offering clozapine to patients with resistant schizophrenia. Methods Descriptive study. Random sample of patients on clozapine attending NHSL, ‘clozapine clinic' were interviewed, and their clinical records reviewed. Results Sample 63 (25 males, 39.68%). Mean age: 34.95 years; mean duration of illness: 13.42 years. Clinical diagnosis in all was schizophrenia. Mean duration on treatment with clozapine was 6.80 years. In 28 (44.44%), two drug trials were tried prior to clozapine; three drug trials in 26 (41.26%); four drug trials in 9 (14.28%). In 49 (77.77%) patients, two second-generation antipsychotics (SGAs) tried prior to clozapine while in 14 (22.22%) three SGAs tried. Entire sample was given both risperidone and olanzapine. Antipsychotic polypharmacy was used in 18 (28.57%). Higher than recommended doses of antipsychotics either alone or in combination, were used in 36 (57.14%). Olanzapine up to 30mg daily was tried in 25 (39.68%). Conclusion There is a considerable delay in offering clozapine to patients with resistant schizophrenia. Multiple drug trials, antipsychotic polypharmacy and administration of higher than recommended drug doses seem to precede clozapine in a large percentage of patients.