ReviewPsychotherapy and psychosomatics2020
A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology.
Review in Psychotherapy and psychosomatics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 72 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
72 citing papers in PubMed, 3 syntheses or guidelines pooled it, 155 citations in OpenAlex.
- Competence and confidence of health care professionals in using clozapine: a qualitative systematic review and thematic synthesis.Acta neuropsychiatrica · 2025Pooled it
- Association Between Clozapine Plasma Concentrations and Treatment Response: A Systematic Review, Meta-analysis and Individual Participant Data Meta-analysis.Clinical pharmacokinetics · 2023Pooled it
- Clozapine prescribing barriers in the management of treatment-resistant schizophrenia: A systematic review.Medicine · 2021Pooled it
- Clozapine levels in inpatients with schizophrenia are not a predictor of rehospitalization: a naturalistic retrospective study.Pharmacological reports : PR · 2026Article
- From Therapeutic Drug to Xenobiotic in Cancer Repurposing: Clozapine Mechanisms, Metabolic Liabilities, and Human-Relevant Translational Approaches.Journal of xenobiotics · 2026Review
- Atypical Neuroleptic Malignant Syndrome Without Rigidity During Clozapine Titration: A Diagnostic Challenge.Cureus · 2026Article
- Clozapine-induced Myocarditis in Korea: Analysis of a Nationwide Database and Comparison to Other Countries.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2026Article
- Clozapine disrupts the gut-lung microbiota axis, linking gastrointestinal hypomotility to increased respiratory vulnerability.Translational psychiatry · 2026Article
- Higher risk of gastrointestinal stenosis and obstruction in clozapine-treated individuals with schizophrenia: a pharmacovigilance study based on the FDA adverse event reporting system database.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- The adverse effects of clozapine on blood markers and electrocardiographic findings in patients with schizophrenia.BioMedicine · 2026Article
- A study on the effect of COVID-19 infection on the serum concentration of antipsychotic drugs.BMC psychiatry · 2025Article
- Rapid On-Demand Point-of-Care Monitoring of Clozapine and Its Metabolite Norclozapine Using Miniature Mass Spectrometry.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Examination of mitochondria- and inflammasome-mediated mechanisms of clozapine-induced myocarditis using patient-derived iPSC cardiomyocytes.Molecular psychiatry · 2025Article
- Elevated neutrophil-to-lymphocyte ratios correlate with increased clozapine concentration-to-dose ratios during titration.Schizophrenia (Heidelberg, Germany) · 2025Article
- Reduced SARS-CoV-2 vaccine-specific antibody response associated with high clozapine doses in schizophrenia spectrum disorders.Brain, behavior, & immunity - health · 2025Article
- Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data.European child & adolescent psychiatry · 2025Article
- Acute exposure to clozapine and sodium valproate impairs oxidative phosphorylation in human cardiac mitochondria.Toxicology reports · 2025Article
- Clozapine is a functional antagonist at cardiac human HNaunyn-Schmiedeberg's archives of pharmacology · 2025Article
- A New Era of Muscarinic Acetylcholine Receptor Modulators in Neurological Diseases, Cancer and Drug Abuse.Pharmaceuticals (Basel, Switzerland) · 2025Review
- DDI-AttendNet: cross attention with structured graph learning for inter-drug connectivity analysis.Frontiers in pharmacology · 2025Article
12 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.