To the Editor: As a psychiatrist and family physician, I appreciated the excellent coverage of schizophrenia by Drs. Crawford and Go.1 I agree that refractory schizophrenia should be treated with clozapine (Clozaril), often earlier during care than is commonly administered. However, clozapine is not available in the United States in a long-acting injectable form, although this would be a wonderful addition to our armamentarium. There are protocols in the U.K.'s Public Health Service for the use of intramuscular clozapine in treatment-refractory psychosis using an unlicensed injectable product made in the Netherlands and imported.2 Clozapine is sometimes administered together with a long-acting antipsychotic in Canadian and U.S. clinics but is generally reserved for the most refractory patients and with close monitoring.3
Editor's Note: This letter was sent to the authors of “Schizophrenia,” who declined to reply.