Expert Consultations: Real-World Answers

Clozapine: Management and Challenges – Interview

Published on February 1, 2025 Certification expiration date: February 1, 2028

Guest

Brian Miller, M.D., Ph.D., M.P.H.

Interview by

Wegdan Rashad

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Highlights

Early signs of improvement in suicidal ideation and aggression can be seen within days to weeks of starting clozapine, making it a valuable option for acute management.
Consider prophylactic metformin or topiramate in patients with family history of diabetes. Monitor closely for metabolic effects and discuss options collaboratively with patients.
Clozapine doses of 50-150mg daily may benefit borderline personality disorder patients with suicidal ideation, impulsivity and psychotic-like symptoms.

Clozapine Formulations and Barriers

Wegdan Rashad, M.D.: I have always been curious about clozapine formulations. I understand that we primarily provide it in oral form, but I wonder if other formulations of clozapine are available and what barriers might exist to developing longer-acting versions.

Brian Miller, M.D.: Regarding

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Learning Objectives:

After completing this activity, the learner will be able to:

Identify appropriate indications for clozapine use, including treatment-resistant schizophrenia, suicidal ideation, and aggressive behavior.
Implement effective strategies for discussing clozapine initiation with patients, including explaining risk-benefit profiles and monitoring requirements in a way that promotes shared decision-making and treatment adherence.
Recognize and develop management approaches for key side effects of clozapine therapy.

Original Release Date: February 1, 2025

Expiration Date: February 1, 2028

Expert: Brian Miller, M.D.

Medical Editors: Wegdan Rashad, M.D., Flavio Guzmán, M.D.

Relevant Financial Disclosures:

Brian Miller declares the following interests:

- Boehringer Ingelheim: Advisory Board

- Bristol Myers Squibb: Advisory Board

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credits.
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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.