What makes clozapine so special?

[swanny]

apparently from what ive read on the internet aswell as what pdocs say clozapine is the "gold standard" of all antipsychotics. we all know antipsychotics block dopamine but is there some special way that clozapine blocks dopamine that makes it the "gold standard". i mean what makes clozapine different from the rest?

[Velvet Elvis]

Studies have just shown it to be more effective than other APs. Because of this it's been been approved for use in treatment resistant schizophrenia despite the potentially fatal risk of agranulocytosis and resulting requirement for blood monitoring.

[swanny]

Studies have just shown it to be more effective than other APs. Because of this it's been been approved for use in treatment resistant schizophrenia despite the potentially fatal risk of agranulocytosis and resulting requirement for blood monitoring.

yes i agree and i know its more effective than other antipsychotics but HOW is it more effective? lets try and stick to the dopamine thing plz.

[Azk]

How clozapine works in cases that don't respond to other APs isn't known at this point.

That's science, sometimes we know something works without knowing why/how it works - to the individual patient, you won't know if it works for you unless you try it.

One thing is for sure - if you never try a med it will never work.

[SashaSue]

Most AAP's work via D2 antagonism. Clozapine interferes to a lesser extent with the binding of dopamine at D1, D2, D3, and D5 receptors, and has a higher affinity for D4.

Animal models suggest clozapine is preferentially more active at limbic than at striatal dopamine receptors, which is believed to contribute to it's relatively mild side effect profile.

None of this really matters though. It will either work for you, or it won't, and the only way to know that is to try it.