After 30 years, clozapine is still best for treatment-resistant patients

摘要

NEARLY half a century after it was introduced, the first atypical antipsychotic drug clozapine (Clozaril) has yet to reach its full potential. In the early 1970s, many psychiatrists questioned whether it could even be a neuroleptic agent because of its lack of extrapyramidal side effects.1 But the subsequent development of a series of second-generation antipsychotic agents, still widely referred to as "atypical" because of their lack of associated movement problems, helped dispel the notion that antipsychotic and extrapyramidal effects must always go together. However, the risk of agranulocytosis with clozapine and the need for regular prophylactic blood monitoring continues to limit the drug's true potential in treatment-resistant schizophrenia.