A Review on the Literature on Clozapine Use in Children Aged 16 and Under

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ABSTRACT Background: Clozapine is a typical antipsychotic, typically used for adult with refractory schizophrenia. It is not approved for use in children and adolescents under the age of 16 years. Aim: The aim of this scoping review is to identify published literature and develop guidance on the practical utilization of clozapine in in children and adolescents. Methods: Five electronic databases (Medline (Ovid), Embase (Ovid), APA Psychinfo (EBSCO), Scopus, and ERIC (EBSCO)) were comprehensively searched for papers published during the period 2000-2021. Also, the reference lists of the screened literature were searched, including a search on Google Scholar. The BNF for Children was contacted seeking their source of information with regard to a clozapine monograph concerning dosages for children under 17 years. Key findings: Overall, 23 papers were included (fulfilled the inclusion criteria). The findings from included literature suggest that, in this population, the time to initiate clozapine, dosages and titration, and the intense monitoring of FBC with differentials are similar to those for adults. However, the target clozapine plasma level for young people should be individualized because several patients showed the clinical effect at a lower than adult clozapine plasma levels (350- 600 ng/mL). Additionally, the incidence rate of adverse events is higher compared to adults, which requires more intense monitoring. Conclusion: This review showed that clozapine can be safely used for children and adolescents, as the higher risk of side effects in this population can be managed and minimized through careful monitoring. Key words: Clozapine, off-label, children, early psychosis, psychotic disorder