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