THE USE OF CLOZAPINE IN PAKISTAN: A STUDY BASED ON CLOZARIL PATIENTS MONITORING SYSTEM (CPMS)
Keywords:
Prescribing pattern, Low dose Clozaril, Pakistan
Abstract
Clozapine is the drug of first choice for Treatment Resistant Schizophrenia (TRS) but it is underutilized and very little information is available about its use in developing countries. We analyzed the medical record of patients who are currently on the data base of Clozapine Monitoring System in Pakistan. Only 1256 patients, almost all concentrated in four major cities were receiving the Clozapine. The mean maintenance dose of Clozapine was 230mg and only a quarter of the psychiatrists working in Pakistan were prescribing Clozpine. The reasons for inadequate use of Clozapine need to be investigated and psychiatric training and perception of the drug needs to be improved in view of the estimated high prevalence of TRS in developing countries.
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References
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28. Taylor DM. Prescribing of clozapine and olanzapine: dosage, polypharmacy and patient ethnicity The Psychiatrist (2004) 28: 241-243 [viewed on 25.4.13] available on http://pb.rcpsych.org/content/28/7/241.full#ref-8
2. Howes Oliver D. ; Vergunst Francis ; Gee Siobhan ; et al.Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation . British Journal of Psychiatry: 2012; 201, 6 481-48
3. Downs J, Zinkler M. Clozapine: national review of postcode prescribing. Psychiatr Bull, 2007;31(10):384-7. doi:10.1192/pb.bp.106.013144.
4. Nielsen J, Røge R, Schjerning O, Sørensen HJ, Taylor D. Geographical and temporal variations in clozapine prescription for schizophrenia. Eur Psychopharmacol. 2012;22(11):818-24.
5. Malalagama G, Bastiampillai T, Dhillon R. Clozapine use in Australia. Australas Psychiatry. 2011;19(2):175.
6. Wheeler AJ. Treatment pathway and patterns of clozapine prescribing for schizophrenia in New Zealand. Ann Pharmacother. 2008;42(6):852-60.
7. Farooq S, Taylor M. Clozapine: dangerous orphan or neglected friend? The British Journal of Psychiatry 2011; 198: 247–249. [viewed on 28.10.13] available at http://bjp.rcpsych.org/content/198/4/247.full.pdf+html
8. Munro J, O'Sullivan D, Andrews C, Arana A, Mortimer A, Kerwin R. Active monitoring of 12,760 clozapine recipients in the UK and Ireland. Beyond pharmacovigilance. British J Psychiatry 1999; 175: 576-580.
9. Latimer E, Wynant W, Clark R, Malla A, Moodie E,Tamblyn R et al. Underprescribing of Clozapine and Unexplained Variation in Use across Hospitals and Regions in the Canadian Province of Québec. Clinical Schizophrenia and related Psychoses 2013, 7:(1); 33-41.
10. Hamirani M, Naqvi A, Saleem MS, Siddidui IA. Clozapine Induced Neutropenia in Patients Suffering from Schizophrenia: A Multi Centre Audit JPPS 2006; 3(1): 39 [viewed on 12.5.12] available on [viewed on 28.1.13] available on http://www.jpps.com.pk/display_articles.asp?d=125&p=art
11. ISM data MAT 3Q 2013.
12. Apiquian R, Fresan A, Fuebte-Sandoval C, Ulloa R and Nicolini H. Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns. BMC Psychiatry. 2004; 4: 12. [viewed on 27.10.13] available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC416660/pdf/1471-244X-4-12.pdf
13. Khan MM. Murky waters: the pharmaceutical industry and psychiatrists in developing countries. Psychiatric Bulletin 2006; 30: 85-88
14. Udomratn P, Ng CH. Outpatient prescribing practices in Asian Countries. In: Ng CH, Lin KM, Singh BS, Chui E, editors. Ethno- psychopharmacology: Advances in current practice. Cambridge: Cambridge University Press, 2008: 135-143
15. Rosenheck R, Cramer J, Weichun Xu, Thomas J, Henderson W, Frisman L, Fle C and Charney D. A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. N Engl J Med 1997; 337: 809-15. [viewed on 24.2.13] available on http://www.nejm.org/doi/pdf/10.1056/NEJM199709183371202
16. Atkin K, Kendall F, Gould D, Freeman H, Lieberman and o’suwvan D Neutropenia and Agranulocytosis in Patients Receiving Clozapine in the UK and Ireland. British Journal of Psychiatry (1996), 169, 483-488 [viewed on 12.6.13] available on http://bjp.rcpsych.org/content/169/4/483.short
17. Clozaril prescribing information. Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936, March 2013 [viewed on 12.6.13] available on http://www.pharma.us.novartis.com/cs/www.pharma.us.novartis.com/product/pi/pdf/Clozaril.pdf
18. keh-ming L, Russell EP, John KL. Robert TR. Haloperidol and Prolactin Concentrations in Asians and Caucasians. J Clin Psychopharmacol 1988; 8: 195-201 [viewed on 15.6.12] available on http://journals.lww.com/psychopharmacology/Abstract/1988/06000/Haloperidol_and_Prolactin_Concentrations_in_Asians.8.aspx
19. MASELLIS, M., BASILE, V. S., ÖZDEMIR, V., et al (2000) Pharmacogenetics of antipsychotic treatment: lessons learned from clozapine. Biological Psychiatry, 47, 252 -266.
20. Lin KM and Finder E. Neuroleptic dosage for Asians. Am J psychiatry 1983; 140: 490-91.
21. Lin KM, Poland RE, Nuccio I, Matsuda K, Hathuc N, Su RE and Fu p. A longitudinal assessment of haloperidol doses and serum concentrations in Asian and Caucasian schizophrenic patients. Am J Psychiatry 1989; 146:1307-1311
22. Collazo Y, Tam R, Sramek J, Herrera J. Neuroleptic dosing in Hispanic and Asian Inpatients with schizophrenia. Mt Sinai J Med. 1996 ; 63(5-6):310-3.
23. Ziguras S, Lambert TJR, McKenzie DP, Pennella J. The influence of client’s ethnicity on psychotropic medication management in community mental health services. Australian and New Zealand Journal of Psychiatry1999; 33 (6): 882–888
24. Bond WS. Ethnicity and psychotropic drugs (Review). Clin Pharm. 1991; 10(6): 467-70. [viewed on 12.4.13] available on http://www.ncbi.nlm.nih.gov/pubmed/1676623
25. Chen JP, Barron C, Lin KM, and Chung H. Prescribing medication for Asians with mental disorders. West J Med. 2002; 176(4): 271–275. [viewed on 18.3.13] available on http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071749/
26. ConnollyA. Race and prescribing (Editorial). The Psychiatrist (2010) 34: 169-171. [viewed on 22.12.12] available on http://pb.rcpsych.org/content/34/5/169.full.pdf+html
27. Bender E. Ethnicity Shouldn't Determine Dosage Decisions. Psychiatric News 2004; 39 (22): 22. [viewed on 25.11.13] available on http://pnhw.psychiatryonline.org/content/39/22/22.1.full
28. Taylor DM. Prescribing of clozapine and olanzapine: dosage, polypharmacy and patient ethnicity The Psychiatrist (2004) 28: 241-243 [viewed on 25.4.13] available on http://pb.rcpsych.org/content/28/7/241.full#ref-8
Published
2025-09-30
How to Cite
1.
Rehman R ur rehman, Farooq S. THE USE OF CLOZAPINE IN PAKISTAN: A STUDY BASED ON CLOZARIL PATIENTS MONITORING SYSTEM (CPMS). J Pak Psychiatr Soc [Internet]. 2025Sep.30 [cited 2025Oct.7];22(03). Available from: https://jpps.pk/index.php/journal/article/view/340
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Short Communication
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