Clozaril: Hope for Unresponsive Schizophrenia

Clozaril (clozapine) is an atypical antipsychotic that until recently had fallen out of favor in the therapeutic community. The drug has been successfully used to treat the symptoms of schizophrenia. In rare cases, Clozaril can cause a drop in white blood cell counts that predisposes a person to serious, possibly life-threatening infection. Attending physicians have been understandably reluctant to prescribe this medication, but a gradual and carefully controlled comeback is underway. For individuals with schizophrenia who have failed to respond to other antipsychotic medications, Clozaril may hold out the promise of a better outcome.

The symptoms of schizophrenia can generally be divided into two categories: positive and negative. Positive symptoms are mental and behavioral effects that are not present in healthy people, such as hallucinations or delusions. Negative symptoms represent the lack of something, such as socialization, emotion, or motivation. Historically, negative symptoms have both been more difficult to treat and more detrimental to a person’s quality of life. Extreme negative symptoms increase the burden on the community and can lead to suicidal thoughts and behaviors. In several clinical trials conducted over the years, Clozaril has shown itself to be at least as effective as similar drugs at treating positive and negative symptoms of schizophrenia.

Even with its apparent effectiveness for the most serious of cases of schizophrenia, Clozaril must be prescribed with the utmost care. It should only be considered when other atypical antipsychotics have not been useful. The U.S. Food and Drug Administration also requires that doctors perform regular blood tests in patients receiving Clozaril both before and during treatment. If white blood cell counts begin to decrease, the medication must be tapered off rather than suddenly terminated. However, the risk of developing this blood condition is not high, and the most common side effects of Clozaril are drowsiness, dizziness, headache, and constipation.

Schizophrenia is a debilitating mental illness, especially when the majority of symptoms are of the negative variety. When other medications and treatments have failed, Clozaril may represent the last option for an improved quality of life. Even taking side effects into account, the long-term prognosis for people with schizophrenia is better when treatment is embraced. Nontreatment nearly always leads to early mortality, more severe symptoms, and low social functioning.


  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of MedicineClozapine. Retrieved March 7, 2012, from
  2. Joober, R., Boksa, P. (2010). Clozapine: a distinct, poorly understood and under-used molecule. Journal of Psychiatry & Neuroscience, 35(3), 147-149.

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