Great question!
Clozapine is not used as a first-line treatment for schizophrenia for several reasons:
Clozapine treatment carries the risk of severe medical conditions including agranulocytosis which leads to dangerous white blood cell reduction myocarditis causing heart muscle inflammation and seizure occurrences. Patients and healthcare providers must deal with burdensome frequent blood tests and close monitoring because of these side effects.
Clozapine remains a potent treatment for treatment-resistant schizophrenia but generates a range of side effects such as sedation and weight gain along with metabolic complications like diabetes and hyperlipidemia. These side effects make long-term treatment difficult and discourage patients from staying consistent with their treatment plans.
Regular blood tests are required for clozapine therapy because of the risk of agranulocytosis and patients find weekly or biweekly monitoring difficult to maintain. All healthcare settings cannot manage this monitoring level.
Due to its associated risks clozapine remains a treatment option only for patients who show no improvement with other antipsychotic drugs. Doctors turn to clozapine as a treatment option only after other antipsychotic medications prove ineffective which explains its position as a non-first-line therapy.
Schizophrenia first-line treatments usually involve atypical antipsychotics such as risperidone, olanzapine, or aripiprazole because these medications offer fewer severe side effects and simpler monitoring processes.
