Published Nov 22, 2002
Lets talk clozaril-
I work in a small out patient mental health clinic. Of our three docs, only one is prescribing clozaril for his pts. These 3 folks are doing remarkable well.
I'd like to see more of our folks on it. What I'd like from you all is testimonials to share.
Any happy stories out there?:roll
we hardy see clozaril due to dangerous side effects and need for blood monitoring.
zyprexa is used big time.
Over here in the UK, Clozaril is used quite extensively with people who have long-term psychotic illness and for whom other meds have proved ineffective. I'm afraid I don't have any miracle stories to tell you - it seems to me that Clozaril hasn't lived up to its hype, but then no antipsychotic could. A lot of the newer ones seem no different than the older ones, quite frankly. Certainly, in terms of aversive side-effects, the huge weight gain associated with olanzapine is no less off-putting than the sedation of haloperidol.
we are seeing the return of haldol, which certainly works quicker than the atypicals. Zyprexa causes weight gain and perhaps also elevated blood sugars. For a little while risperdol was the biggie [ especially when the medical director was a paid 'educator' for it; thankfully this is no longer allowed]. We saw all kinds of problems with it, including neuroleptic malignant syndrome. Everything has side effects, if my loved one was hospitalized I'd want haldol for the short run, zyprexa for long term.
The biggest complaint from the clozaril clients is drooling. OK... I have heard tales that in Europe the blood monitoring is discontiued after a time if no luekopenia is seen.The theory is if a particular pt were to develop agranulocytosis, it wouldnt begin after 2 years, say. It would show up within the first couple of months. These are anecdodal reports I have recieved from drug reps, who clearly have a stake in it. They were not just salespeople, tho- both were PharmDs. We use alot of Geodon also. Both Geodon and zyprexa are quite pricey.
In acute settings they use zydis- oral dissolving olanzapine.
clozaril is a last resort for pt's that all other psychotropics have failed... I think that the state of WV does not want to foot the bill of the $$$$$ it takes to follow a pt and as most chronic psych pts are not gainfully employed...I am a fan of clozaril. I had a pt with severe psychosis for over 20 years begin it and it was like an awakening for her... tolerating it well and has been managing well and is competent for the first time in her life.... I think it needs to be monitored however but should be used with the population of patients that are not responsive to everything else..
We use Zyprexa zydis and seroquel and prolixin ....We use alot of the deconates (haldol, Prolixin) We have used that new GEODON it seems to be useless....Have any thoughts about the GEODON??
haven't seen enough Geodon yet to know anything.
what I wish is drug trials would not just be vs. placebos.
Geodon takes a while... Had a woman who was in and out of the hosp, only 25. Responding really well. Less enraged and her speech now makes sense. I keep looking for the risperidone depo. Maybe they are using it in Europe. One of our docs who also practices in Mexico keeps promising us it's coming. We have several folks on prolixin or haldol depo- They tend to be slippery tho, and we have to catch them when we can. One woman's mother is an lvn and gives her injections at home! Works great, she has not been hospitalized for 10 years.
My friends daughter died from a dvt while on clozapine and I have specialed a clozaril patient in general hosp recovering from a dvt found in time.
However i have many more stories of people who have enriched their lives by regularly taking clozaril. Sure it is risky, and it needs to be monitored, but when u see revolving door patients maintaining a reasonable standard of life in the community, u've gotta say it has benefits that arguably out weigh the deficits.
Clozaril is the gold standard for medications. Clozaril IS risky, and some patient refuse to have the required blood draws.
We are using the risperidone depot here in London. It is a fiddly procedure to draw it up. The results have been no better/worse than trad. depots, frankly.
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