Delay in initiation of clozapine: A retrospective study from a tertiary care hospital in North India

This study aimed to assess the delay in initiation of clozapine, number of adequate antipsychotic trials prior to starting clozapine and practice of polypharmacy prior to starting clozapine. A retrospective study design was followed. Treatment records of 200 patients started on clozapine during the period of January 2006-June 2014 were reviewed. The mean delay in clozapine initiation was 1.93 (S.D. 1.82) years and median was 1.5 years. Mean of 3 (S.D. 1.18) adequate antipsychotic trials was given prior to considering clozapine and 27.5% patients had received polypharmacy prior to clozapine. Factors related to delay in starting of clozapine included higher age, longer duration of illness, age more than 20 years of age, polypharmacy, use of an adequate trial of typical antipsychotic medication, patients from urban locality and those with onset of illness prior to introduction of clozapine into Indian market. Findings of the present study suggest that there is a delay of 1.5-2 years in starting of clozapine and about one-fourth of patients receive polypharmacy prior to receiving clozapine. These finding suggests that there is a need to change the prescribing habits to reduce the delay in starting of clozapine.