Section - Quick Takes

01. An International Adult Guideline for Making Clozapine Titration Safer by Using 6 Ancestry-Based, Personalized Dosing Titrations, CRP, and Clozapine Levels

Published on September 1, 2022 Certification expiration date: September 1, 2028

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Risks of myocarditis and pneumonia deserve as much attention during clozapine titration as does agranulocytosis. Slow outpatient titrations dramatically lower risk.
Monitoring CRP as well as white count improves detection of emergent myocarditis. Adding a troponin level when CRP increases can be used to determine course and whether clozapine must be lowered or discontinued—all in the absence of myocarditis symptoms.
Ethnic ancestry should be used to determine inpatient titration rates as well as CYP1A2 speed.

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Here’s a glimpse of the future of psychiatry, perhaps: Personalized dose titrations for clozapine, 6 different schedules for inpatients. Unfortunately, when you look closely, it’s clear that we’ve got quite a ways to go yet.

Hi! Jim Phelps here for the Psychopharmacology Institute. This is an article with at least 80 coauthors, including some very well-known schizophrenia researchers, describing dosing and titration techniques for clozapine along with important rationales and specific laboratory testing recommendations. I’ll summarize some high points, or you could just jump into the article and its 19 supplementary figures and tables. Let’s start with the big picture.

The authors remind us that treatment-resistant schizophrenia presents its own mortality risks. Therefore, some patients’ risk of dying is actually lower on clozapine than it would be without it, despite the drug risks associated with clozapine. What drug risks? Well, the authors suggest that the American FDA’s focus on agranulocytosis

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02. Misuse of Anticholinergic Medications: A Systematic Review

Learning Objectives:

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

Examine proposed clinical guidelines for the management of clozapine risks during medication titration.
Consider the frequency of anticholinergic misuse relative to other commonly used substances.
Examine rehospitalization rates for patients with first-episode schizophrenia diagnoses and possible implications for antipsychotic dosing for relapse prevention.
Review the impact of metformin in psychiatric patients across 3 studies for the prevention of clozapine-induced weight gain.
Examine findings in a recent systematic umbrella review tackling the serotonin hypothesis of depression.

Original Release Date: September 1, 2022

Review and Re-release Date: September 1, 2025

Expiration Date: September 1, 2028

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

None of the 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 credit.
Download your certificate.

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 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.