Prrescribing Pattern of Clozapine in India: A National Survey of Psychiatrist

PRESCRIBING PATTERN OF CLOZAPINE IN INDIA FOR SUBMISSION TO

THE JOURNAL OF PSYCHOPHARMACOLOGY BY

PRESCRIBING PATTERN OF CLOZAPINE IN INDIA

ABSTRACT

Clozapine is an atypical antipsychotic drug widely used in refractory Schizophrenia . However , drug toxicity , side effects , mortality and tolerability of the drug is a matter of concern in the clinical treatment of Schizophrenia . Hence , Clozapine therapy needs stringent monitoring not only for agranulocytosis but also possible lethal side effects like seizure and myocarditis . Clozapine is available in India since 1996 and a number of psychiatrists have been using

it in their clinical practice . The initial hesitation and difficulty in using this drug seems to be mainly related to the reported side effect of agranulocytosis in 1-2 of patients and requirement of blood monitoring at a weekly interval for at least first few months . This is based on an opinion survey carried out to study relevant aspects of Clozapine using a specifically prepared semi-structured Performa to study the use of Clozapine in clinical practice in India . The analysis of completed Performa received from 117 psychiatrists has shown that Clozapine is a widely used drug in India particularly for the patients of schizophrenia who do not respond to other available antipsychotic drugs . The initiation dose of Clozapine , used by psychiatrists , varies from 12 .5 mg per day to 75 mg per day and the maintenance dose varies from less than 100 mg per day to more than 300 mg per day

Key words : Clozapine , Schizophrenia , Clinical practice , India

INTRODUCTION

Clozapine is a tricyclic dibenzodiazepine derivative 8-chloro-11- (4-methyl-1-piperazinyl )-5H-dibenzo [b , e] [1 ,4] diazepine . It is available as 25mg and 100 mg tablets for oral administration . Clozapine is widely used in refractory Schizophrenia . There seems to be a cultural and geographical variations in dose response relationship and tolerability to the drug making the dose response unpredictable . The effective and tolerable range is between 100 mg to 900 mg , which makes it difficult to make a predictive , significant and valid correlation There has been no positive correlation with serum level too . Clozapine is an atypical neuroleptic drug that has proved to be effective in alleviating psychotic symptoms refractory to treatment with standard neuroleptic drugs . In addition to hematological side effects , an increased susceptibility to epileptic seizures during Clozapine treatment has previously been reported . Seizures are an important adverse effect of Clozapine therapy . The risk of seizures seems to be increased by higher doses ( HYPERLINK "http /www .ncbi .nlm .nih .gov /entrez /query .fcgi ?db pubmed cmd Search itoo l pubmed_Abstract term 22Devinsky O 22 5BAuthor 5D " Devinsky O , 1994 . The vast majority of Clozapine-related seizures are tonic-clonic although myoclonic seizures also occur . A dramatic increase in REM sleep time at the expense of slow wave sleep has been reported in patients on Clozapine monotherapy ( HYPERLINK "http /www .ncbi .nlm .nih .gov /entrez /query .fcgi ?db pubmed cmd Search itoo l pubmed_Abstract term 22Elomaa E 22 5BAuthor 5D " Elomaa E ,1994 Serum Clozapine (S-Cloza ) and serum desmethyl-clozapine concentrations (S-Descloza ) measured in 30 chronic...