Clozapine is a unique antipsychotic primarily indicated for treatmentresistant
schizophrenia, recurrent suicidal behavior in schizophrenia or
schizoaffective disorder, and psychotic disorders in Parkinson’s disease.
It is also prescribed off-label in selected patients with mood disorders,
personality disorders, or post-traumatic stress disorder. Despite its
efficacy, clozapine is underprescribed due to concerns regarding adverse
effects, particularly agranulocytosis. This narrative review aims to
summarize the reported results regarding the off-label use of clozapine
and analyze the potential risks and benefits of these practices. Offlabel
prescribing, which involves using medications for unapproved
indications, is common in psychiatry due to the insufficient effectiveness
of many approved treatments. Clozapine, even at relatively low doses,
has shown potential clinical benefits in patients with bipolar disorder,
borderline personality disorder, and post-traumatic stress disorder.
However, its off-label use remains limited due to safety concerns. The
safety concerns associated with clozapine include agranulocytosis,
myocarditis, cardiomyopathy, seizures, and metabolic syndrome.
The prevention of agranulocytosis, a severe reduction in white blood
cells, requires regular monitoring of blood counts. Myocarditis and
cardiomyopathy necessitate careful cardiological monitoring, especially
during the first month of treatment. Seizures can occur, particularly at
higher doses, and metabolic syndrome, including weight gain, diabetes,
and hyperlipidemia, requires ongoing management. Other adverse
effects such as constipation, hypersalivation, and sedation can also impact
patient compliance and quality of life. Despite these risks, with careful
patient selection, individualized dosing, and continuous monitoring,
the therapeutic potential of clozapine in off-label indications warrants
further exploration in clinical trials.
Keywords: Adverse effects, clozapine, mood disorders, off-label
prescribing, personality disorders, post-traumatic stress disorder