Older patients and those with medical comorbidities can be safely started on clozapine. This course provides detailed practical information about initiating clozapine in older patients and those with concurrent medical issues with a goal of managing pharmacodynamic and pharmacokinetic drug-drug interactions. It also discusses when rechallenge is feasible, and how to maximize the likelihood of clozapine continuation during care transitions.

Learning Objectives

• Explain that elderly patients with treatment schizophrenia can be safely started on clozapine.
• Treat those with higher risk for adverse events (older patients and those with medical comorbidities) with clozapine employing the following common principles: adjustment of titrations; minimizing kinetic drug interactions; and minimizing pharmacodynamic drug interactions, especially those related to risk for sedation, orthostasis and constipation.
• Use clozapine safely in those with cardiometabolic and seizure disorders.
• Identify when to rechallenge and the risks involved.
• Develop methods for communicating and managing unique clozapine related treatment issues to increase acceptance, and as patients transition across settings.

Target Audience

Psychiatrist; Physician (non-psychiatrist)

Estimated Duration

Estimated Duration: 1.0 hour 
Program Start Date: June 1, 2020 
Program End Date: June 1, 2026

Instructional Level

Intermediate

How to Earn Credit

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 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

Presenter

• 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. 

 Planners

• 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.

• John Torous, MD, Beth Israel Deaconess Medical Center. Dr. Torous has no relevant financial relationships to disclose. (Reviewed on 6/4/2023)
• Teri Brister, PhD, LPC, National Alliance on Mental Illness. Reports no financial relationships with commercial interests. (Reviewed on 6/6/2023)

Accessibility for Participants with Disabilities

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 Flash, 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