Folklore

An atypical antipsychotic that I rarely see prescribed anymore is clozapine. Approved by the FDA in 1990 for the treatment of refractory schizophrenia, clozapine has also been shown to benefit patients with severe tardive dyskinesia. Very rarely does clozapine actually cause extrapyramidal side effects.

Alan N. received a trial of clozapine in the past and responded well to the drug. He displays severe, involuntary tremors of his lips, of his arm, and of his hand. He is diagnosed with undifferentiated schizophrenia, chronic. Alan N. has spent almost twenty-five years as a revolving-door mental patient. The guitar is his escape.

A rare but potentially serious side effect of clozapine is agranulocytosis. One would think clozapine would be the drug of choice, with its remarkable therapeutic results in patients with schizophrenia, but the increased risk of agranulocytosis often sidelines its use. Clozapine is also a very costly drug.

The investigative journalist in me has officially come to life. When clozapine was introduced as a landmark drug in 1990, it was available by way of the Clozaril Patient Management System (CPMS). Clozaril is the trade name for clozapine. The CPMS promised to register the patient in a national database, to collect a weekly blood sample, and to arrange, as needed, for a white blood cell count. Any significant findings would then be reported to the patient's psychiatrist.

The CPMS was a costly stunt, keeping clozapine out of reach from the patients who needed it the most. There was no statement made by the FDA about the need for said system; it was a product of the pharmaceutical company that manufactured the drug. Nineteen years later, clozapine is still available, but the LRC avoids this drug.