Clozaril-not doing the trick--now what?

[whopper]

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Anyone know of any good published or anectdotal data on something to add on Clorazaril when its not doing the job & the patient is still suffering from psychosis (dangerous & to the point where they'll harm others)?

Lithium crossed my mind. There's been some data on that. Anyone know of anything else?

 

[atsai3]

Anyone know of any good published or anectdotal data on something to add on Clorazaril when its not doing the job & the patient is still suffering from psychosis (dangerous & to the point where they'll harm others)?

Lithium crossed my mind. There's been some data on that. Anyone know of anything else?

Not a lot of stuff out there. I've encountered a few studies on risperidone + clozapine, but the overall support is mixed. See here:

http://content.nejm.org/cgi/content/abstract/354/5/472
http://ajp.psychiatryonline.org/cgi/content/full/162/1/130

For two recent systematic reviews / meta-analyses, see here:

http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/sbn030v1
http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/sbn018v2

Again, overall mixed results.

Cheers
-AT.

 

[whopper]

Thanks for the links. I have been getting mixed results from my own medical literature investigations, but I haven't seen the NEJM until you pointed it out. That by far is the best study I've seen. Most of them seem to be centered on Risperdal.

 

[1viking]

In-patient?

 

[Anasazi23]

fazaclo.

 

[whopper]

yep inpatient. Young guy, & a nice one too.

 

[Chrismander]

fazaclo.

Does this only have utility in situations where the patient is cheeking or refusing meds? If Whopper's patient is felt to have solid compliance but still psychotic on clozaril (don't know if this is the case) does fazaclo make any difference?

 

[Anasazi23]

I was making a slightly tongue-in-cheek comment really.

Sometimes, psychotic and compliant are mutually exclusive.

It's sometimes worth a trial before adding another med (I'd add another antipsychotic or Li ...probably in loading dose fashion).

 

[whopper]

Never having given Fazaclo out I did some research on it to see if its any better than Clozapine.

Same med, but orally disintegrating--addressed above--great for cheekers.

However the company advertises an 800 number where patients & clinicians can call concerning side effects & claims to be working with Clozapine clinics.

 

[OldPsychDoc]

The other thing I often look at is whether there is an affective component to this that keeps the psychosis "stirred up". Sometimes a mood stabilizer (Li of course being mentioned already, but I've had good results with valproate) can tip the scales in a good direction. (If it's valproate, you'll be tipping the scales big time in other ways with clozapine aboard, but anyway...🙁 )

 

[Doc Samson]

Are you checking levels?