11: Clozapine
Risk Management and Treatment » Pharmacologic and other Somatic Treatments
11: Clozapine
We suggest clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder and either suicidal ideation or a history of suicide attempt(s).
Strength:
Weak for
Category:
ReviewedAmended
Grades and Definitions
- Strong for
- or "We recommend offering this option …"
- Weak for
- or "We suggest offering this option …"
- No recommendation
- or "There is insufficient evidence …"
- Weak against
- or "We suggest not offering this option …"
- Strong against
- or "We recommend against offering this option …"
Categories and Definitions |
||
|---|---|---|
| Evidence Reviewed* | Recommendation Category* | Definition* |
| Reviewed | New-added | New recommendation following review of the evidence |
| New-replaced | Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence | |
| Not changed | Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed | |
| Amended | Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made | |
| Deleted | Recommendation from the previous CPG that has been removed based on review of the evidence | |
| Not reviewed | Not changed | Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed |
| Amended | Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made | |
| Deleted | Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG | |
| *Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72. | ||
Recommendation Resources
Clozapine is an atypical antipsychotic medication that has been found to reduce suicidal behaviors in patients diagnosed with schizophrenia or schizoaffective disorder. The quality and consistency of studies on this are highly variable.
Training and Clinical Resources
This section includes recommended training and/or clinical resources about offering clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder.
- VA National Clozapine Coordinating Center
- An invaluable resource for VA clozapine prescribers. NCCC can offer consultation for difficult cases, as well as, assist with logistics concerns related to prescribing within the VA and difficulties with CPRS related to clozapine. Questions can go: vhaclozapine@va.gov.
- National Clozapine Coordination Center (NCCC) SharePoint (VA Intranet access required)
Manuals
This section includes recommended implementation manuals about offering clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder.
Return to Resource OptionsWebinars
This section includes recommended webinars about offering clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder.
Return to Resource Options
Perceived Barriers and Facilitators of Clozapine Use: A National Survey of Veterans Affairs Prescribers Podcasts
This section includes recommended podcasts about offering clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder.
Return to Resource Options
Unpacking Schizophrenia: Preventing Suicides from Consultant 360: Multidisciplinary Medical Information Network Articles
This section includes recommended articles about offering clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder.
- (2004). The international suicide prevention trial (interSePT): rationale and design of a trial comparing the relative ability of clozapine and olanzapine to reduce suicidal behavior in schizophrenia and schizoaffective patients. Schizophrenia bulletin, 30(3), 577-586. https://doi.org/10.1093/oxfordjournals.schbul.a007102
- (2019). Clozapine and all-cause mortality in treatment-resistant schizophrenia: a historical cohort study. Acta psychiatrica Scandinavica, 139(3). 237–247. https://doi.org/10.1111/acps.12989
- (2005). Suicidal risk during treatment with clozapine: a meta-analysis. Schizophrenia research, 73(2-3). 139–145. https://doi.org/10.1016/j.schres.2004.05.015
- (2011). Managing suicide risk in patients with schizophrenia. CNS drugs, 25(2). 129–143. https://doi.org/10.2165/11586450-000000000-00000
- (2003). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Archives of general psychiatry, 60(1), 82-91. https://doi.org/10.1001/archpsyc.60.1.82
- (2019). Clozapine and Long-Term Mortality Risk in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Studies Lasting 1. -12.5 Years. Schizophrenia bulletin, 45(2). 315–329. https://doi.org/10.1093/schbul/sby052
- (2017). Mortality and Self-Harm in Association With Clozapine in Treatment-Resistant Schizophrenia. The American journal of psychiatry, 174(10). 990–998. https://doi.org/10.1176/appi.ajp.2017.16091097
