Misconceptions and overestimation of clozapine side effects contribute to underprescribing and prescribing variation¶

Claim · All claims
Evidence · 1 study (2 entries) · review r3 · q2
Currency · newest study 2025 · not yet checked against its sources · not reviewed by a person · recheck by 2030: baselines and conditions change

Subclaims¶

q2 i? Fear of side effects and monitoring requirements was consistently reported as a reason for under-prescribing and for variation in prescribing practice across countries and regions. → Secchi Agostina 2025 q2 i? HCPs overestimated the prevalence of clozapine side effects on the majority of LUNSERS items, e.g. on 37 out of 51 items by more than 10%. → Secchi Agostina 2025 (2)

Evidence¶

Secchi Agostina 2025¶

Secchi Agostina, Whiskey Eromona, Nair Sajitha, Shergill Sukhi, Thomas Trudy. (2025). Competence and confidence of health care professionals in using clozapine: a qualitative systematic review and thematic synthesis. Acta Neuropsychiatrica. https://doi.org/10.1017/neu.2025.10024

q2 · i? · review · r3

The review's thematic synthesis: fear of side effects and monitoring was "a reason for under-prescribing clozapine consistently reported by numerous papers" and a source of regional and national prescribing variation.

"Fear of side effects and the need for monitoring was a reason for under-prescribing clozapine consistently reported by numerous papers and it was also one of the reasons for variation in prescribing practice observed in different countries or regions."

Secchi Agostina 2025 (2)¶

Secchi Agostina, Whiskey Eromona, Nair Sajitha, Shergill Sukhi, Thomas Trudy. (2025). Competence and confidence of health care professionals in using clozapine: a qualitative systematic review and thematic synthesis. Acta Neuropsychiatrica. https://doi.org/10.1017/neu.2025.10024

q2 · i? · review · r3

Survey of doctors, nurses and allied health workers reported within the review: respondents "overestimated the prevalence of the side effects by more than 10%" on 37 of 51 LUNSERS items, exemplifying the misconceptions theme.

"HCP (doctors, nurses and allied health workers) surveyed by Hodge and Jespersen (2008), overestimated the prevalence of the side effects by more than 10% on the majority (37 out of 51) of the items listed in the LUNSERS®"

Discussion¶

Related Claims¶

• Exposure to clozapine use is associated with higher prescribing rates and better knowledge — related
• Health care professionals show substantial knowledge gaps about clozapine side effects, especially myocarditis and seizures — related
• Professionals self-report competence with clozapine guidelines but express less confidence in adhering to them — related
• Publication of UK guidelines reduced variation in clozapine prescribing from 34-fold to 5-fold — related