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Abstract：
Using Richardson and Davidson\'s model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
摘要：
利用理查森和戴维森的模型以及药代动力学和临床药物心理学科学，本文综述了:(1)与难治性精神分裂症(TRS)相关的预期寿命差,坚持使用氯氮平的患者可能会有所改善；（2）发现氯氮平是TRS的最佳治疗方法（根据疗效，有效性和幸福感)；和(3)氯氮平可能导致漏洞，包括可能致命的药物不良反应，如粒细胞缺乏症，肺炎,和心肌炎.合理使用要求：（1）在全球范围内修改氯氮平包装说明书，以减少亚洲人的剂量，并避免与肺炎相关的致死性，（2）使用氯氮平水平进行个性化给药，(3)使用缓慢和个性化滴定。这可能使氯氮平尽可能安全，并有助于增加预期寿命和福祉。在氯氮平患者缺乏COVID-19数据的情况下，氯氮平可能损害免疫机制，并可能增加感染患者的肺炎风险。精神科医生应该打电话给他们的氯氮平患者和家属，并向他们解释，如果患者出现发烧或流感样症状，应该召集精神科医生，并考虑将氯氮平剂量减半。如果病人因肺炎住院，治疗医师需要评估氯氮平中毒的症状,因为对所有患者来说,将剂量减半可能是不够的;考虑将其减少至1/3,甚至停用.一旦炎症和发烧的迹象消失，氯氮平剂量可以缓慢增加到之前的剂量水平。
