Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario.
Can J Psychiatry. 2010 Oct;55(10):677-84. doi: 10.1177/070674371005501007.
To review clozapine's position in treatment algorithms for schizophrenia.
Clozapine's status is reviewed in the context of its initial discovery and unique clinical and (or) pharmacological profile, withdrawal and link with hematologic concerns, reintroduction with monitoring guidelines, prototype for atypicality, positioning in treatment algorithms, and current evidence regarding efficacy, effectiveness, and side effects.
The hematologic monitoring implemented with clozapine's reintroduction here in North America has proven successful in preventing clozapine-related deaths secondary to agranulocytosis. While its other side effects are not without concern, present evidence does not link clozapine to increased mortality rates; indeed, it appears better than other antipsychotics in this regard. Moreover, its clinical superiority compared with all other antipsychotics has been confirmed both in efficacy and in effectiveness trials.
Schizophrenia continues to represent a treatment challenge, with many people demonstrating suboptimal response and poor functional outcome. Clozapine is routinely positioned as a third-line treatment in schizophrenia, but in light of existing evidence this warrants re-examination.
回顾氯氮平在精神分裂症治疗方案中的地位。
在氯氮平的最初发现及其独特的临床和（或）药理学特征、停药及其与血液问题的关联、重新引入及其监测指南、作为非典型药物的原型、在治疗方案中的定位，以及目前关于疗效、有效性和副作用的证据的背景下，对氯氮平的地位进行了回顾。
北美实施的氯氮平重新引入时的血液监测已被证明在预防因粒细胞缺乏症导致的氯氮平相关死亡方面取得了成功。虽然它的其他副作用也令人担忧，但目前的证据并未将氯氮平与死亡率增加联系起来；事实上，它在这方面似乎优于其他抗精神病药物。此外，它在疗效和有效性试验中的临床优势已得到证实，优于所有其他抗精神病药物。
精神分裂症仍然是一种治疗挑战，许多人表现出疗效不佳和功能结果不佳。氯氮平通常被定位为精神分裂症的三线治疗药物，但鉴于现有证据，这需要重新考虑。
