The assertive approach to clozapine: Nasogastric administration

Alex Till, James Selwood, Edward Silva*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

9 Citations (Scopus)
529 Downloads (Pure)


Aims and method

An ‘assertive approach’ to clozapine, where nasogastric administration is approved, is assessed through a case-load analysis to provide the first systematic description of its use and outcomes worldwide.


Five of the most extremely ill patients with treatment-resistant schizophrenia were established and/or maintained on clozapine, resulting in improvements to their mental state; incidents were reduced, segregation was terminated and progression to less restrictive environments was achieved.

Clinical implications

Despite being underutilised and rarely enforced, in extreme circumstances, an assertive approach to clozapine can be justified. Nasogastric clozapine can be safely delivered and the approach itself, rather than actual nasogastric administration, may be enough to help establish and maintain patients with treatment-resistant schizophrenia on the most effective treatment.

Declaration of interest

E.S. has received speaker fees from Jansen Pharmaceuticals and Novartis.
Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalBJPsych Bulletin
Issue number1
Early online date18 Sept 2018
Publication statusPublished - Feb 2019


  • Psychotic disorders
  • psychosis
  • schizophrenia
  • antipsychotics
  • clozapine
  • nasogastric administration


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