Clozapine is the only medication approved by the US FDA for treatment-resistant schizophrenia and remains highly underutilized for many reasons, including its unique side effect profile and required hematologic monitoring. This presentation will help build prescriber knowledge and confidence by taking a deep dive into clozapine’s pharmacodynamics and pharmacokinetics. Clozapine’s mechanism of action is not fully understood, but its receptor binding affinity differentiates it from other antipsychotics and may provide insights into the complex etiology of schizophrenia. We will review the proposed mechanism of clozapine side effects including neutropenia, myocarditis, sedation, orthostatic hypotension, constipation, and sialorrhea will discuss evidence-based management strategies.  Clozapine has the potential to cause clinically relevant drug-drug interactions, which will be highlighted.  Finally, we will discuss the value of obtaining clozapine levels and how to interpret them. 

Format

Recorded webinar, non-interactive, self-paced distance learning activity with post-test.

This presentation was recorded on July 15, 2021.

Learning Objectives

• List two hypotheses for why clozapine has unique efficacy in treatment-resistant schizophrenia. 
• Compare and contrast the pharmacodynamic properties of clozapine to other antipsychotics. 
• Explain how clozapine’s mechanism of action at various receptors contribute to its unique side effect profile. 
• Describe three scenarios where therapeutic drug monitoring for clozapine could be useful. 

Target Audience

Nurse/Nurse Practitioner, Pharmacist, Psychiatrist, Physician (Non-psychiatrist), Physician Assistant 

Instructional Level

Intermediate

Estimate Time to Complete

Estimated Duration: 1.0 hour 
Program Start Date: July 20, 2021  
Program End Date: July 20, 2024

Ongoing Interdisciplinary Discussion Board

After completing the course, engage with colleagues in the mental health field through SMI Adviser's Webinar Roundtable Topics discussion board. This is an easy way to network and share ideas with other clinicians who participate in this webinar. Access through the discussion tab.

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™, nursing continuing professional development psychopharmacology contact hours (NCPD, formerly CNE), or a certificate of participation may do so by viewing the live presentation and completing the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), NCPD (nurses), or certificate of participation (other disciplines) showing the event date and hours earned.  

Continuing Education Credit

Physicians

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

 The APA designates this live event for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Nurses/Nurse Practitioners 

The American Psychiatric Nurses Association is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.  

Faculty and Planner Disclosures

All financial relationships relevant to this activity have been mitigated.

Instructor

• Robert O. Cotes, MD, is an Associate Professor at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. He serves as Co-Director of the PSTAR Clinic (Persistent Symptoms: Treatment, Assessment and Recovery), Director of Project ARROW (Achieving Recovery through Resilience, Optimism, and Wellness) and Co-Director of Open Dialogue Atlanta at Grady's Outpatient Behavioral Health Clinic. The PSTAR Clinic provides evidence-based, recovery-oriented care for individuals with persistent symptoms of psychosis, specializing in the use of clozapine. Project ARROW is a coordinated specialty care team for people experiencing first episode psychosis, offering comprehensive, person-centered care using a multidisciplinary approach. He is a member of the Clinical Expert Team for SMI Adviser. SMI Adviser is a joint initiative of American Psychiatric Association and Substance Abuse and Mental Health Services Administration that provides evidence-based resources to clinicians, individuals with serious mental illness, and their families. Dr. Cotes is an investigator for multiple research studies focused on treatment options for psychosis. His research focuses on clozapine, mitigating cardiometabolic side effects of antipsychotic medications, and first episode psychosis. Dr. Cotes reports no financial relationships with commercial interests. 

Planners

• Teri Brister, PhD, LPC, National Alliance on Mental Illness. Reports no financial relationships with commercial interests. 
• Tristan Gorrindo, MD, American Psychiatric Association. Reports no financial relationships with commercial interests. 
• Donna Rolin, PhD, APRN, University of Texas at Austin. Reports no financial relationships with commercial interests.  

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact SMIadviserhelp@psych.org for technical assistance