An evaluation of the variation and underuse of clozapine in the United Kingdom

@article{Whiskey2021AnEO,
  title={An evaluation of the variation and underuse of clozapine in the United Kingdom},
  author={Eromona Whiskey and Amanda Barnard and Ebenezer Oloyede and Olubanke Dzahini and David Taylor and Sukhwinder S. Shergill},
  journal={Acta Psychiatrica Scandinavica},
  year={2021},
  volume={143}
}
Clozapine is the only licensed treatment for treatment refractory schizophrenia. Despite this, it remains grossly underused relative to the prevalence of refractory schizophrenia. The extent of underuse and the degree of regional variation in prescribing in the United Kingdom is unknown. It is also unclear, how the UK compares with other European countries in rates of clozapine prescribing. 

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References

SHOWING 1-10 OF 66 REFERENCES

Practitioner attitudes to clozapine initiation

This survey aimed to clarify barriers to prescribing and elucidate factors that may improve patient access to clozapine, the most effective antipsychotic for treatment‐resistant schizophrenia.

International trends in clozapine use: a study in 17 countries

This study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis.

Clozapine: a review of clinical practice guidelines and prescribing trends

Clozapine effectiveness in the treatment of refractory schizophrenia has been sustained by published evidence in the last two decades, but more efforts are needed to properly inform and support prescribers’ practices.

Clinician hesitation prior to clozapine initiation: is it justifiable?

It is hypothesised here that for others, clinicians' attitudes and preferences are the most likely predictive factors for clozapine initiation, and that underutilisation and delay to initiation remain rife.

Worldwide Differences in Regulations of Clozapine Use

Clozapine remains the drug of choice for treatment-resistant schizophrenia. As a consequence of its long history and complex pharmacology, we suspected wide variation in the regulations of clozapine

Underprescribing of clozapine and unexplained variation in use across hospitals and regions in the Canadian province of Québec.

BACKGROUND Clozapine remains the antipsychotic of choice for people who, having met the criteria for a diagnosis of schizophrenia or a related psychotic disorder, do not respond adequately to other

Clozapine Underutilization in the Treatment of Schizophrenia: How Can Clozapine Prescription Rates Be Improved?

C lozapine has a long-standing, unchallenged track record as the only effective and approved medication for treatment-refractory schizophrenia and is underprescribed, but doctors and patients may be concerned about, or unfamiliar with, the unusual and hazardous adverse effects of clozapine.

Management of treatment resistance in schizophrenia

Skating on thin ice: pragmatic prescribing for medication refractory schizophrenia

Clozapine monotherapy is clearly the optimal medication in medication refractory schizophrenia and it is possible to maximise its use, and augmentation with sodium valproate, lithium, amisulpride and quetiapine, in that order, is a reasonable treatment algorithm.
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