Thursday, November 10, 2005

Clozaril: The Gold Standard

by Adrienne Berkowitz (Class of '05)

Wakefield, MA. Sitting in a crowded room at the outpatient mental health clinic, 15 patients wait their turn for their bimonthly blood tests. A young woman, unfamiliar to the group enters the room. One of the patients interrupts his conversations and asks the woman if she is on Clozaril. The woman says no and is asked to leave the room. The 15 patients feel that their group is special, only those who are on Clozaril are allowed to attend their meetings. Clozaril has changed their lives and they have a special bond with other group members who have shared their positive experiences.

Riverside Counseling Center holds Clozaril Clinics every two weeks for people with a diagnosis of schizophrenia. This disorder affects approximately one in every 100 people. According to the National Institute of Mental Health (NIMH), approximately 200 million people will develop schizophrenia in their lifetime. Schizophrenia is a thought or psychotic disorder. However, psychosis may be present only for some periods during the course of the disease. Common characteristics of schizophrenia are delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, a limited ability to express emotions and feelings, a lack or interest or energy unaccompanied by depressed affect, and an inability to sustain concentration or attention.

Clozaril, the gold standard among antipsychotic medications for people with schizophrenia, was approved by the Federal Drug Administration (FDA) for general use in 1990. Clozaril is a tricyclic dibenzodiazepine derivative, made up of 8-chloro-11-(4-methyl-1-piperazinyl)-5H-dibenzo [b,e] [1,4] diazepine. The active ingredient is clozapine, a yellow, crystalline powder which is very slightly soluble in water. The inactive ingredients are colloidal silicon dioxide, lactose, magnesium stearate, povidone, starch (corn), and talc.

Clozaril is considered the gold standard because it is the most successful antipsychotic medication for people with schizophrenia who have not responded well to other medications. Clozaril is unique medication which treats positive symptoms such as hallucinations, delusions, and bizarre behavior and hostility. It also treats negative symptoms such as blunted emotions, lack of motivation and inability to experience pleasure. All the other antipsychotic medications are compared to Clozaril, giving the medication the name of the gold standard.

Even though it is considered the gold standard, Clozaril is only prescribed after other medications have been unsuccessful. Clozaril can deplete white blood cells, and requires a blood test every two weeks. If a patient’s white blood cell count gets too low, the patient has an increased risk of developing infections. Blood tests are necessary to detect the blood disorder at an early stage so that the patient can stop taking the drug immediately if necessary. Other problematic side effects may include drooling and bedwetting while asleep, feeling drowsy, and weight gain.

Carol Vanderlippe RNCS, LMHC, a nurse at Riverside, starts the Clozaril meeting by asking the patients how they feel. Many of the patients reply that they feel groggy and tired, a common side effect of the medication. However the benefits outweigh the problematic side effects. When Vanderlippe asks if the patients have noticed a difference with their new medication, Clozaril, the room is instantly filled with positive feedback. The patients tell stories about sleeping better, being able to perform everyday tasks, feeling less moody, being able to focus and enjoy life. Since 1990 when Clozaril was introduced, thousands of people have been able to maintain a high level of function. This Gold Standard drug will be around for a long time because the benefits outweigh the risks.

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