Clozapine plasma levels and dosing strategies in patients with treatment-refractory schizophrenia

Peter F Buckley, P. Cola, M. Hasegawa, C. Lys, P. Thompson

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the effect on clinical response to clozapine of increasing the plasma levels of clozapine and its major metabolite N- desmethylclozapine in 19 patients with schizophrenia who had plasma clozapine levels ≤ 370ng/ml, a level previously determined to identify patients who were unlikely to have an adequate response to clozapine. Method: The dosage of clozapine was increased by 20% in 11 patients and left unaltered in the other eight patients. Clozapine and N-desmethylclozapine plasma levels were measured after six weeks at the higher dose. Results: Nine of the 11 patients in whom clozapine dosage was increased subsequently achieved plasma clozapine levels ≤ 370ng/ml. However, in this group of patients who already had partially responded to clozapine, increasing the dosage of clozapine did not produce additional clinical improvement. Conclusion: Clozapine plasma levels are useful in clinical practice to guide dosage strategies. However, these results suggest that increasing the dosage of clozapine to achieve plasma levels ≤ 370ng/ml is unlikely to produce further improvement in patients who have already achieved a partial response to clozapine at plasma levels ≤ 370ng/ml.

Original languageEnglish (US)
Pages (from-to)85-88
Number of pages4
JournalIrish Journal of Psychological Medicine
Volume14
Issue number3
DOIs
StatePublished - Jan 1 1997

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health
  • History and Philosophy of Science

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