[Clozapine--the neglected potential]

Clozapine has been in use since 1975. It was withdrawn due to its toxic effects on granulocytes. It was reintroduced due to its positive effect on schizophrenia in patients who did not respond to two antipsychotic drugs. These patients suffer from a chronic debilitating disease, with numerous and sometimes chronic hospitalizations. Clozapine also has antiaggression and antisuicide effects, as well as specific effects on the negative symptoms of schizophrenia. There are severe side effects that may appear. These include suppression of granulocytes, cardiotoxic effect on the myocard, as well as cardiac conduction defects. It may also cause weight gain and early appearance of diabetis mellitus. All these side effects require strict and intensive monitoring. Clozapine blood Levels are needed for ascertaining the required dose. This article describes several reasons for the low level of use of clozapine in Israel. These include its side effect profile, tendency to use new medications, the demanding monitoring for side effects and the need for long term treatment to achieve clinical improvement.