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Directly observed therapy for clozapine with concomitant methadone prescription: a method for improving adherence and outcome
  1. Nicholas Tze Ping Pang1,
  2. Mohd Fadzli Mohamad Isa2,
  3. Vikram Suarn Singh3,
  4. Ruziana Masiran4
  1. 1Department of Psychiatry, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  2. 2Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  3. 3Department of Psychiatry, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  4. 4Department of Psychiatry, University Putra Malaysia, Serdang, Selangor, Malaysia
  1. Correspondence to Dr Ruziana Masiran, ruziana78m{at}


A young male presented with many years of delusions and hallucinations, with concurrent heroin use and subsequent amphetamine uses. There were no depressive or manic symptoms and psychotic symptoms prior to the amphetamine use. After the trials of two atypical antipsychotics and later clozapine due to treatment resistance, adherence and functionality were poor and there was still persistent drug use. As a result, a long acting injectable adjunct was commenced, but only minimal effects were observed. However after initiation of directly observed treatment of clozapine with methadone, there has been functional and clinical response and drug use has ceased.

  • schizophrenia
  • psychiatry (drugs and medicines)
  • drug misuse (including addiction)
  • drugs misuse (including addiction)

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  • Contributors NTPP, MFMI and VSS were involved in the clinical management of the case. NTPP and RM drafted and finalised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.