Clozapine Management in Santa Monica

Who this is for

• Adults whose psychotic symptoms have persisted after two adequate antipsychotic trials.
• Patients who were started on clozapine in the hospital and need an outpatient prescriber to continue it.
• Patients who stopped clozapine because of side effects and want to know whether a retrial is reasonable.
• Patients with persistent suicidality in the context of schizophrenia or schizoaffective disorder.
• Clinicians seeking consultation on a difficult titration, a plateau in response, or an adverse effect.

What management involves

Care begins by confirming that the criteria for treatment resistance are genuinely met and that adherence, dosing, and diagnosis have all been accounted for. From there the process covers baseline labs and cardiac screening, registry enrollment and absolute neutrophil count monitoring, an individualized titration schedule, and plasma level guided dose adjustment rather than dosing by milligram alone.

Ongoing management addresses the side effects that most often derail treatment: sedation, hypersalivation, constipation and the risk of ileus, orthostasis, tachycardia, weight and metabolic change, seizure risk at higher levels, and early recognition of myocarditis and neutropenia.

Deeper clinical reference

This page describes the clinical service. The detailed educational material, including titration protocols, monitoring schedules, and the myocarditis algorithm, lives in the clozapine primer.