17.1 Clozapine Underutilization with Jose Rubio, MD

Renegade Psych

Clozapine is one of the first antipsychotics with a unique chemical structure compared to any other antipsychotic. It is the most effective at treating patients with treatment-resistant schizophrenia, but is severely underutilized despite its efficacy. It does have a significant side effect profile that needs to be monitored and managed, but can provide relief to patients who have not found relief from other medications. Today, I bring on Jose Rubio, MD, at Zucker Hillside Hospital, who specializes in treatment-resistant schizophrenia and is an expert on using Clozapine. He also trained under John Kane, the original MD and researcher who was tasked by the FDA, which was trying to ban Clozapine due to a string of Scandinavian deaths related to a rare side effect, to bring inpatient treatment-resistant schizophrenic patients in the 1970s OFF of clozapine, and came back to the FDA saying that he wasn't able to find effective treatment for the majority of them and petitioned the FDA to reconsider their ban due to Clozapine being so effective. Clozapine is very cheap and is another example of us prioritizing less effective and more expensive treatments over tried-and-true treatments. It DOES have a severe side effect of agranulocytosis (along with a couple others), which impairs the person's immune system to fight off infections, so it requires a significant amount of monitoring especially early in the treatment. But, for the vast majority of patients, Clozapine is not only tolerated, but provides them relief from their symptoms and a chance to live a more normal life. Hope you enjoy!

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