Background:- Clozapine is a second-generation antipsychotic drug which was introduced inrn1961. It has wide clinical utility particularly for patients with treatment-resistant schizophrenia.rnPrescription of clozapine shows a considerable variation across countries. There is a general delayrnin its initiation partly because of its adverse effects, unavailability of clozapine and psychiatristrnattitudes towards the medication. Many studies have investigated clinical characteristics, adverserneffect profile and treatment outcomes over time internationally. However, to the best of ourrnknowledge, there is only one institution based study in Ethiopian. rnObjective: To assess the outcomes of clozapine treatment in five health facilities in Ethiopia.rnMethod: A retrospective chart review was conducted from May to October, 2020 on patientsrnwho have been treated with clozapine between 2017 to 2020. Data extraction sheet was used tornextract secondary data to assess indications, adverse effects and treatment outcomes of patientsrntreated with clozapine . SPSS version 25 was used for data entry and analysis. rnResults: A total of 84 patients treated with clozapine were recruited and the main indications wererntreatment resistant schizophrenia(TRS) n=60 (71%), treatment resistant schizophrenia withrntardive dyskinesia (TD) n=13(15.5%) and tardive dyskinesia n=10(11.9%). Seventy two (85.7%) rnpatients had improvement of admission complaints upon discharge. The main improved symptomsrnwere positive psychotic symptoms n=67(79.8%), negative symptoms n=52(61.9%), aggressionrnn=33(39.3%), suicidal behavior n= 11(13.1%), depressive symptoms n=20(23.8%) andrnimprovement of cognitive function n= 22(26. 2%). In case of TD patients, a mean AIMS scorernof 17.3 at admission reduced to 5.5 upon discharge. The most common side effects were sedationrnn=46(54.8%),sialorrhea n=31(36.9),constipation n=24(28.6%),weight gain n=18(21.4%) andrntransient hematological abnormalities n=14(16.7%). Serious side effect found were seizure n=rn4(4.8%), persistent tachycardia n= 2(2.3%) and myocarditis n= 1(1.2%) rnConclusion and Recommendation:rnClozapine was indicated for treatment of TRS and TD, which resulted in improvement ofrnadmission complaints. Most of the side effects were tolerable and manageable. The main identifiedrnreason for discontinuation of the medication was unavailability. Having seen the indications,rntolerable adverse effects and better treatment outcomes of clozapine, we recommend that patientsrnwith TRS and TD to be enrolled in clozapine treatment as soon as treatment-resistance isrnconfirmed.