Clozapine treatment and risk of unplanned pregnancy.

With recent advances in the medical treatment of chronic psychiatric patients who are capable of living productive lives in their communities, follow-up of these patients is often carried out by their family physicians. These family physicians are also generally responsible for family planning. Many schizophrenic patients have preserved sex drives, but their judgments and responsibilities with respect to contraception are impaired. Often the family physician has to deal with lack of cooperation from these patients when they are asked to use common forms of contraception. Some family physicians rely on the infertility secondary to hyperprolactinemia caused by traditional antipsychotic agents. Clozapine is a new antipsychotic medication, the use of which is increasing rapidly, but not all physicians realize that it does not cause hyperprolactinemia-induced infertility. We present a case of a schizophrenic patient who became pregnant shortly after her antipsychotic treatment was changed to clozapine. The purpose of our report is to increase the awareness of physicians treating patients with clozapine of the possibility of undesired pregnancy when no contraceptive is used.