Tuesday, April 11, 2017

White Paper Offers Recommendations for Expanding Clozapine Use

To reduce barriers to clozapine use, prescribers should collaborate with primary care physicians to manage side effects of the treatment that could arise in patients with schizophrenia.

This was one of several recommendations outlined in a recent white paper addressing the underuse of clozapine—an antipsychotic that remains underprescribed, despite its proven efficacy for the treatment of refractory schizophrenia.

“Our report provides recommendations to different key stakeholders about what they should be doing at a minimum,” said co-author Deanna Kelly, Pharm. D. (pictured above), of the Maryland Psychiatric Research Center. “The barriers to use are related to side effects associated with the drug and a lack of provider education. If everyone plays their part, these barriers are not as significant as they may seem. If access to clozapine is improved, millions of patients could benefit. In turn, their improved care would result in substantial cost savings to the entire health care system,” she told Psychiatric News.

Among other recommendations, which were presented at the International Congress on Schizophrenia Research in San Diego last month, were the following:
  • All acute care and psychiatric hospitals should have clozapine on their formularies as an essential medication and have policies and procedures to facilitate its safe and appropriate use.
  • Psychiatric residency programs should consider including didactic instruction on the use of clozapine and participation in interdisciplinary teams that manage patients on clozapine.
  • Clozapine should be a preferred medication on the pharmacy drug lists of all state Medicaid programs and pharmacy benefit/managed care programs contracting with state Medicaid programs, and on the formularies of Medicare prescription drug programs and other payers of pharmacy benefits.
  • Academic centers, in consultation with state or local mental health authorities, should encourage interdisciplinary consultation centers for community providers such as psychiatric pharmacists or nurse practitioners involved in the management of patients receiving clozapine.
For more coverage of this topic, see an upcoming edition of Psychiatric News. For related information, see the American Journal of Psychiatry article “Comparative Effectiveness of Clozapine and Standard Antipsychotic Treatment in Adults With Schizophrenia” and the Psychiatric Services article “The Business Case for Expanded Clozapine Utilization.”


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