Clozapine is the only antipsychotic that is effective in treatment-resistant schizophrenia. However, in certain clinical situations, such as the emergence of serious adverse effects, it is necessary to discontinue clozapine. Stopping clozapine treatment poses a particular challenge due to the risk of psychotic relapse, as well as the development of withdrawal symptoms. Despite these challenges for the clinician, there is currently no formal guidance on how to safely to discontinue clozapine. We assessed the feasibility of developing evidence-based recommendations for (1) minimizing the risk of withdrawal symptoms, (2) managing withdrawal phenomena, and (3) commencing alternatives treatment when clozapine is discontinued. We then evaluated the recommendations against the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. We produced 19 recommendations. The majority of these recommendation were evidence-based, although the strength of some recommendations was limited by a reliance of studies of medium to low quality. We discuss next steps in the refinement and validation of an evidence-based guideline for stopping clozapine and identify key outstanding questions.

中文翻译：

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降低氯氮平停药后戒断症状和复发的风险——制定循证指南是否可行？

氯氮平是唯一对难治性精神分裂症有效的抗精神病药。但在某些临床情况下，如出现严重不良反应，则有必要停用氯氮平。由于精神病复发的风险以及戒断症状的发展，停止氯氮平治疗带来了特别的挑战。尽管临床医生面临这些挑战，但目前没有关于如何安全停用氯氮平的正式指南。我们评估了针对以下方面制定循证建议的可行性：(1) 尽量减少戒断症状的风险，(2) 管理戒断现象，以及 (3) 在停用氯氮平时开始替代治疗。然后，我们根据研究和评估指南评估 (AGREE) II 标准评估了这些建议。我们提出了 19 条建议。这些建议中的大多数是基于证据的，尽管一些建议的强度受到对中低质量研究的依赖的限制。我们讨论了改进和验证停止氯氮平的循证指南的后续步骤，并确定了关键的悬而未决的问题。