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References Schizophrenia and related psychoses CHAPTER 1 Intramuscular clozapine Intramuscular clozapine is a short-­term intervention for patients with a treatment-­ refractory psychotic disorder who refuse oral medication. It is always used with a view to co...

Long-term antipsychotic treatment 22 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Combined antipsychotics (antipsychotic polypharmacy) In psychiatric practice, prescriptions for combined antipsychotic medications are common1–3 and often long te...

Optimising clozapine treatment

Using clozapine alone

Clozapine augmentation 220 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Optimising clozapine treatment Using clozapine alone Target dose (dose is best adjusted according to patient tolerability and plasma level) ■ ■Average dose in UK is around ...

References 222 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Other options include adding pimozide, olanzapine or sertindole. None is recommended: pimozide and sertindole have important cardiac toxicity and the addition of olanzapine is poorly s...

Alternatives to clozapine 226 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Alternatives to clozapine Clozapine has the strongest evidence for efficacy for schizophrenia that has proved refractory to adequate trials of standard antipsychotic med...

Summary of alternatives to clozapine Schizophrenia and related psychoses CHAPTER 1 Summary of alternatives to clozapine Table 1.54 provides a summary of alternatives to clozapine in refractory schizophrenia. Table 1.54  Summary of alternatives to clozapine in ...

References 230 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Millgate E, et  al. Neuropsychological differences between treatment-­resistant and treatment-­responsive schizophrenia: a meta-­analysis. Psychol Med 2022; 52:1–13. Yoshim...

Restarting clozapine after a break in treatment 234 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Restarting clozapine after a break in treatment Interruptions in clozapine treatment are commonplace.1 Patients prescribed clozapine should be advi...

References Schizophrenia and related psychoses CHAPTER 1 References John AP, et al. Rates and reasons for clozapine treatment interruptions: impact of the frequency of hematologic monitoring and cardiac adverse events. J Clin Psychopharmacol 2023; 43:233–238....

Initiation of clozapine in the community

Adverse effects Schizophrenia and related psychoses CHAPTER 1 monotherapy.24 Although the interpretation of such real-­world findings is hindered by the issue of confounding by indication,25 there are perhaps several plausible explanations for improved efficac...

Relative contraindications to community initiation

Essential criteria for suitability for community initiation

Initial work-up 236 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Initiation of clozapine in the community While in-­patient initiation remains the main method of starting clozapine, community initiation is fairly common in many countries. The l...

Mandatory blood monitoring and registration

Dosing Schizophrenia and related psychoses CHAPTER 1 ■ ■Echocardiogram if clinically indicated. ■ ■Consider work-­up for BEN where baseline neutrophil counts are low (see section on clozapine, neutropenia and lithium in this chapter). Genetic testing for BEN i...