Talk:Clozapine

Too negative?

Most of the article is concerned with potential adverse effects. Just from my own experiences as an inpatient I know it can have very, very positive results. I take it for BPD and it has helped a hell of a lot.

My psychologist was telling me about a big study in a US psych hospital where a very significant number of treatment-resistant schizophrenic patients recovered enough to leave hospital after a fairly short time on clozapine. There isn't much about the benefits or the studies that proved it was worth prescribing in spite of the side effects.

Elijah Rosewater — Preceding unsigned comment added by 109.204.111.61 (talk) 15:44, 19 February 2015 (UTC)

FA

@Casliber: I was looking at the collaborations section on your user page. Are you still interested in improving this article and pushing it through FAC? From experience, drug articles typically require multiple rounds at FAC since they seldom generate input from enough reviewers the first time around. In any event, I noticed you haven't edited this article since 2010, so I'm wondering if you're still willing to commit. Seppi333 (Insert 2¢) 08:48, 10 August 2019 (UTC)

I find it hard to get enthusiastic about taking medical articles through the GA?FA process, but I'll take another look. Which just reminds me of another promise I made.Cas Liber (talk · contribs) 09:20, 10 August 2019 (UTC)

Clozapine was not completely withdrawn from the market between 1975 and 1985.

Currently, the article states that:

"In 1975, after reports of agranulocytosis leading to death in some clozapine-treated patients, clozapine was voluntarily withdrawn by the manufacturer.[70] ..."

While this appears to be true in some countries (notably Finland), Sandoz AG continued to provide Leponex to patients in Switzerland, Germany and Czechoslovakia, provided that a specialised psychiatrist has prescribed it to them and done the necessary blood work, sharing the results of the haematology with Sandoz research. This is important, because it helped to estabilish a functioning therapeutic monitoring for a last resort drug, as well as demonstrate that clozapine is both a highly effective antipsychotic and that it can be prescribed to outpatients fairly safely, if the necessary therapeutic monitoring is adhered to. Cheers,--95.208.240.109 (talk) 22:32, 16 August 2020 (UTC)

§Clozapine is classified as a GABA antagonist and GABA modulator according to CHEBI (www.ebi.ac.uk)§

Clozapine is classified as a GABA antagonist and GABA modulator according to CHEBI — Preceding unsigned comment added by 79.106.215.39 (talk) 19:49, 10 November 2020 (UTC)

References

Injectible form / miscategorization of edits

The protocol information documented by "Protocol for the use of intramuscular (IM) clozapine injection" (Sussex Partnership NHS Foundation Trust) shows that doctors may administer injectible clozapine to patients who refuse to take it, that this involved painful administration, injection into multiple sites simultaneously at higher doses, and blood sample testing to monitor blood levels. This source and this information should not be deleted without cause. I can add further sources that corroborate this upon request.

The report from the United Nations Special Rappoteur that describes forced injections of psychotropics as a human rights abuse is cited both directly (the actual report that the Rappoteur delivered) and cited in a report from the National Association for Rights Protection and Advocacy. One user inappropriately deleted these sources and described them as "removing a Scientology reference" - highly inappropriate as neither the United Nations nor NARPA is a Scientologist organization (to claim that they were would be a conspiracy theory.) Another user said that "no secondary sources were given" - this is also not true, the UN Rappoteur's report was cited in a secondary source, AKA the NARPA report. Furthermore I don't think "secondary sources" are even necessary in this case, ie the full PDF of the report directly from the UN would be fully sufficient as a citation for the statement "The report from the UN describes this as a human rights violation." ARMILLARIA.9 (talk) 13:47, 14 August 2021 (UTC)

You need a reliable secondary source that specifically talks about clozapine in detail (not just in passing), anything else would be irrelevant and non-notable to this article. That Narpa site doesn't strike me as a reliable source, nor does it even mention clozapine anywhere.--Megaman en m (talk) 14:06, 14 August 2021 (UTC)

"Doesn't strike me as a reliable source" is vague and subjective. However, noted and I'll only use sources that talk about this drug specifically, and not about this class of drugs generally. In the meantime, please stop deleting the Sussex Partnership protocol source and the specific information that's cited in it. ARMILLARIA.9 (talk) 14:19, 14 August 2021 (UTC)

ARMILLARIA.9, this is a primary source, not a secondary source. It is not appropriate for such a claim that is A) controversial and B) does not have sources added that show how it is WP:DUE. This may be true in some instances, but is it relevant in the context and in the appropriate weight? That is where I disagree, and it appears Megaman also disagrees.--Shibbolethink ^{(♔ ♕)} 16:51, 14 August 2021 (UTC)

I would argue the source is a secondary source (see WP:MEDRS, "Examples [of secondary sources] include literature reviews or systematic reviews found in medical journals, specialist academic or professional books, and medical guidelines or position statements published by major health organizations.". The source (https://www.sussexpartnership.nhs.uk/sites/default/files/documents/im_cloz_-_trust_protocol_-v1_-_0417_-_final_0.pdf) specifically addresses intramuscular clozapine injections. The title is "Protocol for the use of intramuscular (IM) clozapine injection". With that the sussex branch of the NHS only contains a million people or so, and NICE guidelines are to be considered more authoritative (though they can be higher level and less detailed than the guidelines produced by bodies). A search of NICE's website with google yields no result for "Intramuscular clozazpine" and I failed to find any systematic reviews on google scholar.

This source (an editorial in BJPsych) might be a better source constituting a review (rather than a guideline). https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/should-intramuscular-clozapine-be-adopted-into-mainstream-clinical-practice/AEE6D680CB3E19F453E1F17DDD918970. Establishing the notability of the topic of safety of IM Clozapine, from this source we have, "This means that, as an unlicensed product in the UK and its country of origin, it falls within the highest-level risk category in the Medicines and Healthcare products Regulatory Agency (MHRA) hierarchy of medicines availability.5 In addition, from a medicines safety perspective, administration errors with intramuscular clozapine would be high risk, especially given the unfamiliarity with its use."

I doubt many sources will specifically address the question of whether clozapine injection are painful, rather they will likely address IM antipsychotic injections in general. It would feel appropriate to include such information about IM antipsychotics in general in this source. Perhaps summarizing and linking to the antipsychotic article directly. You might argue that constitutes original research through synthesis, but I think this is a stretch. Talpedia (talk) 21:39, 27 August 2021 (UTC)

Word choice within introduction

The use of the term "gold standard" in the last sentence of the introduction is confusing. As it's already linked to therapy, wording such as highest indicated drug therapy or first line treatment might be more clear for some. Might need to be rewritten but I'm not comfortable doing that 2605:A601:A184:7800:3BA7:CA5D:6555:206F (talk) 12:25, 1 April 2023 (UTC)

"advert"

an "advert" tag was applied in a drive-by fashion with no discussion. i removed it. Biosthmors (talk) 12:14, 25 March 2024 (UTC)

Underuse of clozapine section

The "underuse of clozapine" section seems unnecessarily long and detailed to me, and I'm concerned about NPOV. (It's also refbombed beyond all recognition). Would anyone object to me trimming this section down and focusing on just a couple of high-value references? WeirdNAnnoyed (talk) 18:36, 23 July 2024 (UTC)

"Neutropenia" section is contradictory

"(...)in the first 18 weeks of treatment meta-analysis of controlled trial data also fails to show that clozapine has a stronger association with neutropenia than other antipsychotic medications(...)."

Immediately after that:

"After one year, this risk reduces to that associated with most antipsychotics" Douweziel (talk) 03:55, 30 October 2024 (UTC)