Refractory schizophrenia and clozapine Flashcards
Starting dose
12.5mg nocte
What should happen in the first six hours following the first dose of clozapine
Hourly BP monitoring, not necessary if first dose given nocte
Day 2 dosing
12.5mg BD
Titration after day 2
If tolerating, can increase by 25-50mg/day until 300mg/day
Suggested starting regime for inpatients
Day 1: 12.5mg nocte Day 2: 12.5 BD Day 3/4: 25 BD Day 5/6: 25, 50 Day 7: 50 BD Day 8: 50, 75 Day 9: 75 BD Day 10: 75, 100 Day 11: 100 BD Day 12: 100, 125 Continue increasing by 25mg/day (increased dose at nocte)
Target dose for female non-smokers
250mg/day
Target dose male non-smokers
350mg/day
Target dose female smokers
450mg/day
Duration of initial titration
over ~3 weeks
Further dose increases
50-100mg / week
Target plasma level for adequate trial
350 ug/L
when may slower titration be necessary
Elderly, physically compromised, young, previously poorly tolerated antipsychotics
Evidence about clozapine augmentation and when should it be abandoned
little evidence to suggest anything more than a very small effect with augmentation using other antipsychotics
if attempted, should be done slowly, if no effect, abandon after 3-6 months
augmentation with amisulpride
400-800 mg, may allow dose reduction
augmentation with aripriprazole
15-30 mg may improve metabolic parameters
