Results of studies to date assessing an adequate trial duration of clozapine conflict. Early recommendations were to treat patients for six months at a therapeutic dose before considering it ineffective . However, Conley et al have reported that lack of response at eight weeks predicts a similar outcome at six months. At this time, a three- to six-month trial is recommended considering that clozapine is reserved for patients failing to respond to first line treatment and the lack of other effective alternatives. birth control pills
The importance of treatment compliance needs to be emphasized with clozapine responders. It appears from the quantity of anecdotal reports, some exceptionally well documented, that the risk of early and severe relapse upon discontinuation is significantly greater with clozapine than with other antipsychotic agents . The recommended management for acute decompensation is the immediate reintroduction of clozapine, if possible. Initially, lower doses should be used if the patient has been noncompliant for several days to avoid significant side effects such as orthostatic hypotension and sedation. For patients who refuse or should not be retreated with clozapine, agents with similar receptor pharmacology are recommended as the follow-up therapy (eg, thioridazine, olanzapine).
Overall, clozapine should be used as third line therapy after at least two antipsychotics have been tried and failed to achieve a satisfactory response. Some, but not all, suggest that failure to respond to two novel antipsychotics justifies a trial of clozapine, while others continue to recommend that clozapine should not be tried until inadequate response is also demonstrated with conventional neuroleptic treatment.