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Clozapine-Related Adverse Events and Managing Inadequate Response

Activity Type:

  • On Demand

Release Date: 6/1/2020

Expiration Date: 6/1/2023

  • AMA PRA Category 1: 1
  • Participation: 1



The key to keeping patients on clozapine is management of adverse effects and optimizing response. This presentation provides detailed practical information about strategies to mitigate weight gain, how to distinguish benign fever from other conditions (myocarditis, nephritis), and when to suspect cardiomyopathy. There is also be a discussion of why routine seizure prophylaxis with divalproex is not necessary and might be harmful, and methods for addressing nonresponse.


FREE - $0

Funding for this initiative was made possible (in part) by Grant No. 1H79SM080818-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. 

Learning Objectives

  • Discuss the rationale for and dosing of prophylactic use of metformin to manage clozapine related weight gain.
  • Identify that seizures are easily managed and should never be a reason to discontinue clozapine treatment. 
  • Express the conclusions that, due to the low prevalence of seizures, prophylactic anticonvulsants should not be used as these will be unnecessary in > 98% of patients.
  • Diagnose myocarditis and interstitial nephritis, and distinguish these from benign fever and benign eosinophilia
  • Recognize the need for evaluation of cardiomyopathy
  • Explain that there is a known incidence of hematologic abnormalities other than neutropenia, including leukocytosis, neutrophilia, thrombocytosis, thrombocytopenia and anemia
  • Manage inadequate clozapine response

Target Audience

Psychiatrist; Physician (non-psychiatrist)

Estimated Duration

Estimated Duration: 1.0 hour 
Program Start Date: June 1, 2020 
Program End Date: June 1, 2023

Instructional Level


How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™ or a certificate of participation may do so by completing all sections of the course, including 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) or certificate of participation (non-physicians) showing the completion date and hours earned.

Continuing Education Credit


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 enduring 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.

Faculty and Planner Disclosures


  • Jonathan Meyer, MD, Clinical Professor of Psychiatry, University of California, San Diego. Disclosures - Consultant: Acadia Pharmaceuticals, Alkermes, Abbvie, Intra-Cellular Therapies, Neurocrine; Speaker Bureau: Acadia Pharmaceuticals, Alkermes, Janssen Pharmaceutica, Neurocrine, Otsuka America, Inc., Sunovion Pharmaceuticals, and Teva Pharmaceutical Industries Ltd. 


  • Tristan Gorrindo, MD, American Psychiatric Association.  Reports no financial relationships with commercial interests.
  • Teri Brister, PhD, National Alliance on Mental Illness. 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.

Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This website 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 Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration

  • Browser: Firefox (latest version), Internet Explorer 8.0+, Safari 7.0+, Microsoft Edge (latest version) or Google Chrome (latest version)
  • Operating System: Windows XP+ or Mac OS X 10.4+
  • Flash Player: Adobe Flash Player 10.3+ 
  • Internet Connection: 1 Mbps or higher

Minimum Requirements

  • Windows PC: 500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Macromedia Flash Player 10.3 or higher; Sound Card at least 16-bit; audio playback with speakers for programs with video content
  • Macintosh:Mac OS X 10.4+ or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit; audio playback with speakers for programs with video content

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