Prescription practices and attitude of psychiatrists towards clozapine: A survey of psychiatrists from India

•Majority of the psychiatrists rated effectiveness of clozapine to be better than other antipsychotics.•Majority of psychiatrists rated tolerability of clozapine to same or better than other antipsychotics.•The most common reason for not starting clozapine by the psychiatrists was need for heamatological monitoring.

AimTo assess the attitude of psychiatrists towards clozapine and also to evaluate the prescription practices of psychiatrists for clozapine.MethodologyAn email survey was sent to 3381 psychiatrists from India, of whom 548 (16.2%) responded.ResultsMean number of years in clinical practice was 12.59 (SD—10.1) for participating psychiatrists. Majority of the participants rated their knowledge about clozapine to be good (61.5%)/very good (34.5%). The primary indication for use of clozapine for almost all the participants was treatment resistance and most of the psychiatrists initiated clozapine either in the dose of 25 mg OD (44.3%) or 12.5 mg OD (37%). Half (51.8%) of the psychiatrists preferred to use clozapine as BD dosing schedule, and median doses required to stabilize the patients ranged from 137.5 to 400 mg/day. Once the clozapine dose had been stabilized, about half (51%) of the psychiatrists advised blood monitoring at monthly intervals. Almost all psychiatrists rated effectiveness of clozapine to be better than other antipsychotics. In terms of tolerability, 45.3% of the psychiatrists rated it as ‘same as other antipsychotics’ and 15.9% rated it as better than other antipsychotics. Most common patient and therapist related factors associated with reluctance to start clozapine were history of poor medication compliance and need for monitoring, respectively. Upon reviewing the prescription of other psychiatrists, participating psychiatrists reported that in about 28.46% of patients clozapine was not prescribed though indicated.ConclusionsThis survey suggests that clozapine is underused in India, although psychiatrists have adequate knowledge about the drug but many psychiatrists have negative attitude towards clozapine.