Episode Outline: The Clozaril Story

1. Introduction

• Importance of clozapine in psychiatric training

• FDA-approved uses

2. Clozaril Monitoring & Side Effects

• ANC monitoring (weekly → biweekly → monthly)

• Blood levels: draw at ≥300 mg/day, after Luvox, or with toxicity/inefficacy

• Common side effects: sedation, constipation, sialorrhea, seizures, myocarditis

3. Patient Impact

• Clozaril as a life-changing intervention

• Examples of stabilization and regained functioning

4. Off-Label Uses

• Bipolar disorder with psychosis or aggression

• Borderline personality disorder with self-harm/aggression

• Parkinson’s disease psychosis

• Psychotic depression

• Forensic violence/aggression

• Treatment-resistant OCD

5. Augmentation Strategies

• Luvox: boosts clozapine levels via CYP1A2 inhibition

• Aripiprazole, cariprazine, amisulpride (Europe), risperidone/olanzapine

• When to augment: residual symptoms, clozapine under-response, side effect limits

6. Key Clinical Takeaways

• Always supervise Clozaril initiation

• Know when to draw levels

• Document rationale and response

• Respect Clozaril’s power—and its complexity