Intramuscular Clozapine: A Systematic Scoping Review of Clinical Feasibility, Safety, and Efficacy.
Noori Dhaliwal, Sid Kaladharan, Jana Waldmann et al.
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From the abstract
The use of oral clozapine for treatment-resistant schizophrenia (TRS) is often limited by acute psychotic symptoms and medical instability. Intramuscular (IMI) clozapine has been infrequently used as a bridge to oral therapy. This literature review considers the available evidence regarding IMI clozapine's feasibility, effectiveness, and safety.
Reported results
Twenty records met the inclusion criteria, primarily consisting of case reports or series; no randomized trials were identified. Half of the included studies were rated as either "fair" or "good" quality (n=11/20). Most records addressed the initiation of clozapine in the context of oral (PO) refusal, with services describing IMI clozapine as feasible within strict governance guidelines and pharmacy support.
Authors' conclusions
The existing literature suggests that IMI clozapine may be used as a time-limited intervention to support continued PO administration. Further prospective studies with standardized procedures, patient-centered outcomes, and extended follow-up periods are necessary to inform clinical practice and policy development.