Treatment-resistant schizophrenia (TRS) will afect about one in three patients with schizophrenia. Clozapine is the only treatment approved for TRS, and patients should be treated as soon as possible to improve their chances of achieving remission. Despite its efectiveness, concern over side efects, monitoring requirements, and inexperience with prescribing often result in long delays that can expose patients to unnecessary risks and compromise their chances of achieving favorable long-term outcomes. We critically reviewed the literature on clozapine use in TRS, focusing on guidelines, systematic reviews, and algorithms to identify strategies for improving clozapine safety and tolerability. Based on this, we have provided an overview of strategies to support early initiation of clozapine in patients with TRS based on the latest evidence and our clinical experience, and have summarized the key elements in a practical, evidence-based checklist for identifying and managing patients with TRS, with the aim of increasing confdence in prescribing and monitoring clozapine therapy.

难治性精神分裂症 (TRS) 将影响约三分之一的精神分裂症患者。氯氮平是唯一获批用于 TRS 的治疗药物，患者应尽快接受治疗，以提高其获得缓解的机会。尽管其有效，但对副作用、监测要求的担忧和处方经验不足通常会导致长期延迟，使患者暴露于不必要的风险，并损害其获得有利长期结局的机会。我们对关于氯氮平用于 TRS 的文献进行了批判性综述，重点关注指南、系统综述和算法，以确定改善氯氮平安全性和耐受性的策略。基于此，我们根据最新证据和我们的临床经验，概述了支持 TRS 患者早期开始使用氯氮平的策略，并总结了识别和管理 TRS 患者的实用、基于证据的检查表中的关键要素，目的是增加处方和监测氯氮平治疗的信心。