Treatment-resistant schizophrenia means two failed antipsychotic trials, each at an adequate dose and for an adequate time, and a patient who simply did not take the medication has not had a trial. This is where clozapine belongs: it works about 60 percent of the time when other antipsychotics work about 5 percent, so save it for real treatment resistance.
What counts as treatment resistant
It means two failed antipsychotic trials, each for an adequate time (typically about six weeks) and at an adequate dose (600 chlorpromazine, or Thorazine, equivalents).
“It's two failed antipsychotic treatments for an adequate time, and typically that's about six weeks. And then the antipsychotic needs to be at an adequate dose. And there we're talking about 600 thorazine equivalents”
5:08Top 10 Things to Know About ClozapineDec 2025 It does not count as a trial if the patient just does not take the medication. We saw this all the time in the hospital: a patient got called treatment resistant because they kept coming back.
“it doesn't count as a trial if someone just doesn't take the medication. So I would see this all the time in the hospital. We would call it, someone would call it treatment resistant schizophrenia because the patient kept coming back to the hospital”
5:53Top 10 Things to Know About ClozapineDec 2025
Clozapine
In treatment-resistant schizophrenia, clozapine works about 60 percent of the time. That is even more impressive given how ineffective other antipsychotics are at that point: they work about 5 percent of the time.
“when we're talking about treatment-resistant schizophrenia, it works about 60% of the time. And that's even more impressive when you consider how ineffective other antipsychotics are at that point. So other drugs work about 5% of the time”
7:15Top 10 Things to Know About ClozapineDec 2025 Save clozapine for treatment-resistant schizophrenia; you do not want to get too loosey-goosey with it.
“make sure you save it for treatment-resistant schizophrenia because you don't want to get too loosey-goosey. And we're going to be talking about the reasons why that is”
8:07Top 10 Things to Know About ClozapineDec 2025
From these episodes
- Top 10 Things to Know About ClozapineDec 2025 · 4 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.