Medical experts clash over use of 'danger' schizophrenia drug

Caution is killing patients earlier, claims new study by doctors in The Lancet

Excessive caution by drug regulators in Britain and abroad has contributed to the deaths of thousands of patients with severe mental illness, say doctors.

Patients with schizophrenia have been condemned to second-rate treatments, often for years, which are less effective at controlling the illness and preventing suicide because of misplaced anxiety about the safety of the most effective drug, clozapine. The pharmaceutical industry also bears a share of the responsibility for restricting the use of clozapine because it promotes more expensive but less effective drugs which bring it more profit, the doctors say today in The Lancet.

A new study shows that clozapine, always thought to be a dangerous drug, actually cut the death rate among patients with schizophrenia by 26 per cent, compared with the standard treatment. But the finding was challenged by British experts who said the serious side effects linked with clozapine meant patients needed close monitoring and it would always be a drug of last resort.

Worldwide, millions of patients with severe mental illness are treated with antipsychotic drugs to control their delusions and hallucinations. Evidence shows that, on average, they die 25 years earlier than those in the general population, partly because of increased smoking and obesity, but also by suicide.

Professor Jari Tiihonen, of the University of Kuopio, Finland, and colleagues say that the introduction of newer antipsychotics, including clozapine, in the 1990s is widely thought to have increased deaths among patients with schizophrenia. But an analysis of the data shows that, while some drugs were associated with an increased risk, clozapine lowered the risk of dying the most, despite being the drug most closely restricted by the authorities because of safety concerns.

Clozapine can cause agranulocytoisis, which destroys the white blood cells and causes falls in blood pressure, convulsions, diabetes and weight gain. Patients must have regular blood tests while taking it. Professor Tiihonen said: "In all western countries, clozapine is recommended for use only as a second-line drug, after at least two other anti-psychotics have been tried and failed. I would like to see it considered for first line use. Doctors and the [drug regulatory] authorities are too cautious.

"Patients with schizophrenia may suffer delusions and hallucinations for years while doctors try different anti-psychotics before they get to clozapine. They are not active enough in getting patients into remission. They should try clozapine earlier." In a study two years ago in the British Medical Journal, Professor Tiihonen showed that patients were less likely to stop taking taking clozapine than other anti-psychotics, despite its side effects. "Patients are more willing to use it, probably because it is effective," he said.

But Professor Tim Kendall, deputy director of the Royal College of Psychiatrist's research unit, said a major study of clozapine in China showed it was no more effective than the older antipsychotic chlorpromazine. "The evidence for first-line use is not there. Clozapine is associated with a much broader range of side-effects. It seems to have a different effect and works better in people who have tried other drugs which have failed. These findings should be interpreted with real caution."

Les Iversen, professor of pharmacology at the University of Oxford, said: "I cannot agree that clozapine should be the drug of first choice for treating schizophrenia. This is because the adverse side effect of agranulocytosis is serious and can be life-threatening. It occurs in about 2 per cent of patients, and all patients require tedious and costly monitoring, initially weekly, later monthly to detect this side-effect. For this reason, clozapine has become a drug of last resort, and will probably remain so."

Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Service Delivery Manager

    Negotiable: Recruitment Genius: A Service Delivery Manager is required to join...

    Recruitment Genius: Massage Therapist / Sports Therapist

    £12000 - £24000 per annum: Recruitment Genius: A opportunity has arisen for a ...

    Ashdown Group: Practice Accountant - Bournemouth - £38,000

    £32000 - £38000 per annum: Ashdown Group: A successful accountancy practice in...

    SThree: Trainee Recruitment Consultant

    £18000 - £23000 per annum + Uncapped commission: SThree: Does earning a 6 figu...

    Day In a Page

    The saffron censorship that governs India: Why national pride and religious sentiment trump freedom of expression

    The saffron censorship that governs India

    Zareer Masani reveals why national pride and religious sentiment trump freedom of expression
    Prince Charles' 'black spider' letters to be published 'within weeks'

    Prince Charles' 'black spider' letters to be published 'within weeks'

    Supreme Court rules Dominic Grieve's ministerial veto was invalid
    Distressed Zayn Malik fans are cutting themselves - how did fandom get so dark?

    How did fandom get so dark?

    Grief over Zayn Malik's exit from One Direction seemed amusing until stories of mass 'cutting' emerged. Experts tell Gillian Orr the distress is real, and the girls need support
    The galaxy collisions that shed light on unseen parallel Universe

    The cosmic collisions that have shed light on unseen parallel Universe

    Dark matter study gives scientists insight into mystery of space
    The Swedes are adding a gender-neutral pronoun to their dictionary

    Swedes introduce gender-neutral pronoun

    Why, asks Simon Usborne, must English still struggle awkwardly with the likes of 's/he' and 'they'?
    Disney's mega money-making formula: 'Human' remakes of cartoon classics are part of a lucrative, long-term creative plan

    Disney's mega money-making formula

    'Human' remakes of cartoon classics are part of a lucrative, long-term creative plan
    Lobster has gone mainstream with supermarket bargains for £10 or less - but is it any good?

    Lobster has gone mainstream

    Anthea Gerrie, raised on meaty specimens from the waters around Maine, reveals how to cook up an affordable feast
    Easter 2015: 14 best decorations

    14 best Easter decorations

    Get into the Easter spirit with our pick of accessories, ornaments and tableware
    Paul Scholes column: Gareth Bale would be a perfect fit at Manchester United and could turn them into serious title contenders next season

    Paul Scholes column

    Gareth Bale would be a perfect fit at Manchester United and could turn them into serious title contenders next season
    Inside the Kansas greenhouses where Monsanto is 'playing God' with the future of the planet

    The future of GM

    The greenhouses where Monsanto 'plays God' with the future of the planet
    Britain's mild winters could be numbered: why global warming is leaving UK chillier

    Britain's mild winters could be numbered

    Gulf Stream is slowing down faster than ever, scientists say
    Government gives £250,000 to Independent appeal

    Government gives £250,000 to Independent appeal

    Donation brings total raised by Homeless Veterans campaign to at least £1.25m
    Oh dear, the most borrowed book at Bank of England library doesn't inspire confidence

    The most borrowed book at Bank of England library? Oh dear

    The book's fifth edition is used for Edexcel exams
    Cowslips vs honeysuckle: The hunt for the UK’s favourite wildflower

    Cowslips vs honeysuckle

    It's the hunt for UK’s favourite wildflower
    Child abuse scandal: Did a botched blackmail attempt by South African intelligence help Cyril Smith escape justice?

    Did a botched blackmail attempt help Cyril Smith escape justice?

    A fresh twist reveals the Liberal MP was targeted by the notorious South African intelligence agency Boss