Data From the World Health Organization’s Pharmacovigilance Database Supports the Prominent Role of Pneumonia in Mortality Associated With Clozapine Adverse Drug Reactions

Extract

Although clozapine is underprescribed in many countries, it may be the most efficacious antipsychotic and the best for treatment-refractory schizophrenia. Moreover, a meta-analysis¹ reported significantly lower deaths in patients continuously treated with clozapine compared to other antipsychotics.

This editorial proposes that clozapine mortality may be further decreased by paying more attention to pneumonia. The prominent role of pneumonia in clozapine mortality is supported by an update of a review article² and by the new data from a global database of adverse drug reactions (ADRs) for comparing the mortality associated with pneumonia and other clozapine ADRs.

Update of a Review Article

The experience with his state’s mortality reviews led the first author to complete a comprehensive review² of the literature on the swallowing disturbances associated with antipsychotics, including complications such as pneumonia. In 2005, using postmarketing surveillance, the Food and Drug Administration reported the association between antipsychotics and deaths in dementia patients was partly linked with pneumonia and began requiring a warning about “esophageal dysmotility and aspiration.” Clozapine is rarely used in dementia patients, but the warning was included in its package insert.²