An inquiry into various aspects of clozapine use: prescription, monitoring and mortality

Yvonne Catharina van der Zalm

Research output: ThesisDoctoral ThesisExternal prepared

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This thesis concerns clozapine, an antipsychotic for patients with schizophrenia for whom other antipsychotics were not effective. The treatment is labor-intensive because of the weekly blood tests during the first 18 weeks. Is case of an abnormality (1-2%), the treatment has to be discontinued. That is why the drug is prescribed less often than desired. This research examined prescription rates in outpatient teams and an intervention to stimulate prescribing: delegating the clozapine monitoring to nurse practitioners. It was found that the prescription rates in the Netherlands differed strongly per team and are on average high compared to those in other countries. The intervention did not lead to significantly more prescriptions.
The research also used data on the Danish population to investigate whether the use of clozapine is associated with an increased mortality. One would expect an increased cardiovascular mortality because this drug often leads to serious obesity, but this was not found. No difference was found between clozapine and other antipsychotics in all-cause mortality, cardiovascular mortality or suicides. The research did find a high risk of suicide after discontinuation of clozapine.
Original languageEnglish
Awarding Institution
  • Maastricht University
  • Selten, J.P., Supervisor
  • Sommer, Iris, Supervisor, External person
  • Schulte, Peter F., Co-Supervisor, External person
  • Termorshuizen, F., Co-Supervisor, External person
Award date18 Jun 2021
Place of PublicationMaastricht
Print ISBNs9789464232202
Publication statusPublished - 2021


  • clozapine
  • prescription
  • psychosis
  • outpatient care
  • mortality

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