Podcasts about Clozapine

This story is a mirror to Elizabeth's story from season 1 episode 1. Today's storyteller Sarah was so moved by Elizabeth's story that it helped her to trust Dr. H's recommendation to take a pretty scary medication, the extremely powerful antipsychotic and mood stabilizer called clozapine. So why tell this story again? As they say, history doesn't repeat itself, but it does often rhyme, and Sarah's story rhymes beautifully with Elizabeth's. Both had severe and treatment resistant bipolar 1 disorder, formerly known as manic-depression. Both tried all the meds, did all the things, then eventually reached a point of utter hopelessness and despair….and then they had to trust Dr. H enough to try one more thing.Support the show! https://www.buzzsprout.com/396871/support"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/BFTA episode recommendations/Podcast pagehttps://www.craigheacockmd.com/podcast-page/Support the show

Meds that require special skill to start: Clozapine and lamotrigine.CME: Take the CME Post-Test for this EpisodePublished On: 09/15/2025Duration: 10 minutes, 19 secondsChris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Welcome Back! We have recently partnered with Psych Congress to bring our audience access to some of their leading speakers and educators, and today is the second installment of this endeavor, featuring Dr. Jonathan Meyer on the topic of Antipsychotic plasma level monitoring. Dr. Meyer has authored the handbook on this topic, along with the Lithium and Clozapine handbooks as well. You can find them here: https://www.amazon.com/s?k=jonathan+meyer&crid=3IARW0R4T9RGD&sprefix=jona%2Caps%2C369Psych Congress Discount Code: PSYCHROUNDSConference Website: https://www.hmpglobalevents.com/psych-congressSources:- https://www.cambridge.org/core/books/clinical-use-of-antipsychotic-plasma-levels/E7C0B6DBB4F6031F4D47935154CBEC8D

In this episode, we explore the puzzling connection between clozapine and obsessive-compulsive symptoms in schizophrenia patients. Does this wonder drug actually cause OCD, or are we missing a deeper story about how protective behaviors transform into compulsive habits? Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CME: Quick Take Vol. 70 Clozapine and OCD-Like Symptoms: What's the Connection?

In this episode, we explore the potentially fatal side effects of clozapine that often receive less attention than agranulocytosis: bowel obstruction and pneumonia. Could your vigilant monitoring of blood counts be overshadowing equally dangerous risks? Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CME: Quick Take Vol. 69 Clozapine: The Hidden Risks of Ileus and Pneumonia

In this second episode of our World Schizophrenia Day series, we revisit a controversial debate.Anti-psychotics like Abilify, Risperdal, and Clozapine are often used to help manage a person's symptoms of schizophrenia, including paranoia, delusions and hallucinations. However, there’s a movement that wants to shift mainstream thinking away from using medication to manage the symptoms of a serious mental illness. It encourages people to accept and live with the symptoms of severe mental illness, such as delusions and hallucinations.To help us navigate this hot-button dilemma, we talk to a Look Again recurring guest, Dr. Diane McIntosh, Psychiatrist and Clinical Assistant Professor at the University of British Columbia.Follow Look Again to listen to insightful conversations like this one that examine the treatment of severe mental illness. Until then, share your thoughts with us here. Leave a review so others can find our show.Resources:Dr. Diane McIntosh - BioBlindsided - Dr. Diane McIntosh's podcastAntipsychotic Selection Is Important for Reduced Nonadherence in SchizophreniaLook Again Season 1, Episode 5: The Truth Behind Psychiatric MedicationAnti-Psychotic Medication - CAMHSee omnystudio.com/listener for privacy information.

Send us a textIn this episode we are discussing the importance of provider-family partnerships for people with complex needs.Cheryl Jameson is our guest and she was in conversation with Emily Webb, host of this podcast, at the Complex Needs Conference in late March for the lived experience stream.A mental health support worker of many years, Cheryl found herself on the other side of systems when her eldest child Josh was 16 and developed psychosis. He was diagnosed with schizophrenia, which was drug-resistant for many years.  We discover how her family has navigated systems and worked with providers to ensure Josh has the support he needs and wants. Josh gave his consent for his mum to speak to us about their journey so far.ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.Helplines (Australia):Lifeline 13 11 14QLIFE 1800 184 52713 YARN 13 92 76Suicide Callback Service 1300 659 467ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.

There's a care model for schizophrenia that actually works—why isn't it everywhere? On this episode, W. Gordon Frankle, MD, MBA, Vice Chair of Psychiatry at NYU Langone Health, shares how his team in Brooklyn is building a new model for treating serious mental illness—one rooted in long-term, relationship-driven, team-based care. From wraparound services to precision psychiatry, this conversation explores what happens when you bring humanity, structure, and innovation to a population too often left behind.Also discussed:The first novel schizophrenia drug in over 50 years (Cobenfy)Why clozapine is underused—and how that may finally changeThe potential of brain imaging and biomarkers in psychiatric treatmentWhat a real community mental health system looks likeWhy trust, not just treatment, is essential for recovery

Send us a textEric Smith shares his remarkable journey from child piano prodigy to mental health advocate after battling psychosis and addiction. His story reveals how finding the right medication after a decade of failed treatments transformed his life from hospitalization and FBI involvement to becoming a Texas Judicial Commissioner on Mental Health.• Displayed extraordinary musical talent from age three, studying under world-renowned pianists and performing with Grammy winners• Experienced early warning signs when grades declined in middle school, with a psychologist predicting future psychosis• Developed full-blown psychosis after getting sober, believing he had decoded assassination plots involving world leaders• Contacted the FBI about his delusions, leading to multiple meetings before his parents sought help from his former psychiatrist• Required three hospitalizations over several years before finding success with Clozapine after more than 10 years of failed medications• Experienced a profound moment of clarity two weeks after starting Clozapine when the "noise" in his mind quieted• Returned to education, maintaining a perfect 4.0 GPA through graduate school• Now serves as a commissioner with the Texas Judicial Commission on Mental Health and runs his own consulting business• Advocates for better access to effective treatments like Clozapine, which international guidelines recommend after two failed antipsychoticsVisit www.ericwtsmith.com to learn more about Eric's consulting work or to contact him directly.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

Dr. Jose de Leon speaks with Dr. Julia Ann Koretski, the Journal of Clinical Psychopharmacology's Digital Editor, about practical strategies for clinicians prescribing clozapine. This discussion builds on another podcast episode in which Dr. de Leon and a panel of authors and editors discuss recommendations to the FDA to make important changes to the drug's product label to reflect current knowledge about the drug's pharmacology, safety profile, and proper titration. Dr. de Leon, Professor of Psychiatry at the University of Kentucky College of Medicine, is the lead author of two articles on the topic in the May-June 2025 issue of JCP. In this podcast, Dr. de Leon elaborates on some of the complexities involved in managing clozapine use, given individual differences in clozapine metabolism as well as genetic and ethnic variabilities among groups. He stresses, however, that clozapine is a life-saving tool that can reduce the risk of suicide in people with schizophrenia.       Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I   Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts.  Part II

It has been more than 35 years since clozapine was approved by the FDA for use in the United States. Since then, there have been major advances in pharmacokinetics as well as a substantial accumulation of real-world evidence about its use. In two articles in the May-June 2025 issue of the Journal of Clinical Psychopharmacology, Dr. Jose de Leon and dozens of colleagues call on the FDA to make important changes to the drug's product label to reflect current knowledge about the drug's pharmacology, safety profile, and proper titration. The stakes are high: The medication can be used effectively for treatment-resistant schizophrenia, but there has been concern that it has been underused, resulting in poorer outcomes for patients, including a high rate of suicides. Updating the package insert would help to educate clinicians on its proper use and monitoring for adverse effects. In this podcast, Dr. Julia Ann Koretski, JCP's digital editor, leads a panel discussion on the articles by Dr. de Leon and colleagues. In addition to Dr. de Leon, the other panelists include Dr. Larry Alphs, author of an editorial about the topic, Dr. Richard Balon, a coauthor and JCP Associate Editor, and Dr. Anthony Rothschild, a coauthor and Editor-in-Chief of the journal.   Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I   Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts.  Part II   Incorporating Real -World Treatment Data Into Clozapine's Product Label

In this episode, we explore a landmark Finnish study examining the long-term risk of agranulocytosis in patients taking clozapine. The research followed 62,000 patients over 22 years, providing crucial data about this rare but serious side effect. Could these findings change how we approach clozapine prescribing and monitoring requirements? Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.75 CME: Quick Take Vol. 66 Does Clozapine's Agranulocytosis Risk Persist Beyond Initial Treatment Period?

Join Dr. David Puder and expert psychopharmacologist Dr. Michael Cummings in a detailed discussion on Clozapine, the gold standard medication for treatment-resistant schizophrenia. They explore recent significant updates, including the removal of the Clozapine REMS program, which simplifies patient care and medication management. This episode covers optimal dosing practices, managing side effects, crucial drug interactions, and approaches to related conditions such as catatonia. An essential resource for psychiatrists and mental health professionals seeking updated clinical insights. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

REMS requirement removed for schizophrenia treatment; new copper intrauterine device approved; Wegovy, Ozempic no longer in short supply; stem cell therapy for chronic lumbar disc disease fast tracked; ecopipam shows promise for Tourette syndrome.

Sometimes we have a window of opportunity to make a difference. In this series we discuss time-frames where panic, clozapine, and metformin have the greatest benefits.CME: Take the CME Post-Test for this EpisodePublished On: 02/24/2025Duration: 11 minutes, 53 secondsChris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Today, we have a very special guest joining us—Dr. John Kane! We will be discussing his experience and history with clozapine, a groundbreaking medication for treatment-resistant schizophrenia.

The questions answered in this podcast are listed below.They were compiled by GPs and health professionals around Australia. Can you start on Ozempic and up titrate to 1 milligram and then switch to Wegovy if one milligram is not enough OR is the goal to up titrate to 2.4 as it is the most effective dose, so prescribing Wegovy instead? How you can switch between Ozempic to Wegovy?  How about switching from semaglutide to tirzepatide, and liraglutide and saxenda? How quickly will you increase the dose and what dose do we aim for? What are your thoughts on patients that are responding to lower doses but are being prescribed a higher dose pen and trying to micro dose with a larger pen. How long do you keep the patients on semaglutide and when do you stop? When do you even think about the intermittent use of such an agent?    Can semaglutide be given for life? Can the medication be given fortnightly instead of weekly? Patients that want to re-start, will they restart at the dose they stopped at or at a lower dose? Is there a BMI target for patients with T2D? Position statement on T2D remission: When are they going to update and add in the GLP ones? Do we use the same dose or higher doses of Wegovy for adolescence?  What do you think about the use of semaglutide for an adolescent with autism or an adolescent using an anti-psychotic medication such as Clozapine who needs to take it on an ongoing basis? Has the use of semaglutide increased the incidence of restrictive eating disorders? Any indication for use in women with polycystic ovarian syndrome?   Host: Dr David Lim | Total Time: 28 mins Expert: A/Prof Ralph Audehm, General Practitioner Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEDT Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Send a Text to the Moms - please include your contact info if you want a response. thanks!Guests: Robert S Laitman, MD,Mimi Liu, Doro MindAt Doro Mind. the mission is to provide compassionate, accessible, and dynamic care and support for individuals suffering from psychosis and their caregivers.Dr. Robert Laitman is a psychiatric internist dedicated to changing the treatment paradigm for psychosis. He is the author of “Meaningful Recovery from Schizophrenia & Serious Mental Illness with Clozapine” which outlines his families personal story supporting his son through schizophrenia and pioneering a novel evidence based approach to psychosis treatment with clozapine.Mimi Liu is the former COO & CTO of Firefly Health, where she led operations and tech for delivering integrated primary care and behavioral health services. Mimi leads Doro Mind with the personal passion that comes from supporting her brother through his journey with psychosis.Into the Light movie episode : #94Links:https://www.doromind.com/https://www.teamdanielrunningforrecovery.org/Dr. Laitman's book:https://a.co/d/iLrDwvCDaniel Laitman on Youtube:https://youtu.be/uBdJWFvP-uc?si=8ECR7DfhDGc3gdHxMindy and her book: https://mindygreiling.com/Randye and her book: https://www.randyekaye.com/Miriam and her book: https://www.miriam-feldman.com/More Than the Dress“More than the Dress” is a biweekly podcast hosted by Michele C. Meyer-Shipp, Esq.,...Listen on: Apple Podcasts SpotifyWant to know more?Join our facebook page Our websites:Randye KayeMindy Greiling Miriam (Mimi) Feldman

What are the primary barriers to clozapine utilization in the United States, and how do these barriers impact patient care? What are some common misconceptions or negative attitudes among prescribers regarding clozapine, and how can these be addressed? What are some effective strategies for improving the management of clozapine's side effects to encourage its use? What strategies can be implemented to improve education and awareness about clozapine?  Brought to you by the NEI Podcast, the PsychopharmaStahlogy Show tackles the most novel, exciting, and controversial topics in psychopharmacology in a series of themes. This theme is on underutilized psychotropic drugs.  Today, Dr. Andy Cutler interviews Dr. Jonathan Meyer and Dr. Stephen Stahl about factors that have led to the underutilization of clozapine in psychiatry.  Let's listen to Part 3 of our theme: Underutilized Psychiatric Drugs.  Subscribe to the NEI Podcast, so that you don't miss another episode!  Resources  The Clozapine Handbook   Clozapine titrations paper (see Supplementary Material):   de Leon J et al. Pharmacopsychiatry 2022;55(2):73-86.  FDA committees meeting to discuss reevaluation of the Clozapine REMS program (November 19, 2024): click here. 

Internationally renowned bipolar disorder expert Dr. Trisha Suppes unravels the latest science in bipolar disorder treatment by breaking down the proven and cutting-edge treatments available today - exploring traditional solutions such as Lithium and mood stabilizers alongside exciting new options like psilocybin, ketamine, and the Ketogenic diet. Dr. Suppes also navigates the complexities of mania and tackles the perennial question: is lifelong medication necessary to live well with bipolar disorder? (00:00) About Dr. Suppes Medication Treatments (03:00) Is Lithium the Gold Standard? (05:22) Atypical Antipsychotics (07:22) Dangers of Antidepressants? (09:17) Medications Lose Strength? Non-medication Treatments (10:47) Psychotherapy (12:54) Ketogenic Diet & Nutrition (13:28) Cannabis (14:20) Ketamine Brain Stimulation Therapies (15:18) rTMS (Transcranial Magnetic Stimulation) (16:01) VNS (Vagus Nerve Stimulation) (17:07) ECT (Electroconvulsive Therapy) Bipolar Disorder is Complex (18:52) Insight & Denying Bipolar Disorder (22:45) Bipolar I: Need Meds Forever? (23:44) Bipolar II: Need Meds Forever? (26:22) Hypomania Causes Misdiagnosis (28:16) Mixed States Psychedelics (29:28) Psilocybin & Magic Mushrooms (32:33) Microdosing & LSD (34:02) MDMA Closing (35:41) Keeping You "A Little Depressed" (37:55) Why Recovery Is Possible (39:06) Reflecting on Research Impact Dr. Trisha Suppes, M.D., Ph.D., is a distinguished expert on the biology and treatment of bipolar disorder, and mood disorders generally. Dr. Suppes is the Director of Exploratory Therapeutics and Professor at Stanford University in the School of Medicine. At the VA Palo Alto Health Care System, she is Director of the CSP NODES and is the Founder of the Bipolar and Depression Research Program. Her areas of expertise include long-term treatment strategies for bipolar disorder, identification and treatment of bipolar II disorder, treatment of those with bipolar disorders and co-morbid conditions and use of complementary medicine. She has recently launched a new initiative to explore the use of psychedelics for mood disorders and PTSD in Veterans. Dr. Suppes has been integrally involved in numerous initiatives to improve evidence-based treatment for bipolar disorders. Dr. Suppes participated as a member of the DSM-5 Mood Disorders committee on updating the APA DSM-5 criteria for Mood Disorders and was chair of the APA DSM-5 Bipolar Disorder subcommittee. She was the past President of the International Society of Bipolar Disorders (ISBD). Treatments Referenced

In this episode of the Real Life Pharmacology podcast, I cover drugs 16-20 of the top 200 drugs. This podcast includes information about clozapine, furosemide, heparin, tetracycline, and vardenafil. Clozapine has five boxed warnings and these are all items that you may see on your pharmacology and board exams! I've also blogged about these in the past at meded101. Furosemide is a loop diuretic and a common indicator of the prescribing cascade. I discuss this in this podcast episode. Heparin can cause thrombocytopenia. I discuss what HIT (heparin-induced thrombocytopenia) may look like.

In this episode, we welcome back Dr. Michael Cummings to answer questions sent in by podcast listeners. Topics include Valproic Acid, Lithium, Treating Veterans, Restless Leg Syndrome, and much more. 

In this episode, we discuss the management of common adverse effects associated with clozapine treatment, including myocarditis, cardiomyopathy, tachycardia, orthostatic hypotension, and metabolic syndrome. How can clinicians mitigate these risks while optimizing treatment outcomes for patients with treatment-resistant schizophrenia? Faculty: Brian Miller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Clozapine: Management and Challenges Managing Cardiac and Metabolic Adverse Effects of Clozapine

In this episode, we navigate the complexities of initiating and optimizing clozapine treatment for patients with treatment-resistant schizophrenia. How do you chart the course for successful clozapine therapy while managing side effects and drug interactions? Join us as Dr. Brian Miller shares his expertise and valuable psychopharmacology pearls. Faculty: Brian Miller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CMEs: Clozapine: Management and Challenges Initiating and Optimizing Clozapine

In this episode, we delve into the use of clozapine for treatment-resistant psychosis and mood disorders. When should clinicians consider clozapine, and what do expert guidelines recommend? Dr. Brian Miller guides us through the evidence and best practices for utilizing this powerful but often underused medication. Faculty: Brian Miller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Clozapine: Management and Challenges Using Clozapine for Treatment-Resistant Psychosis and Mood Disorders

In this episode, we discuss the treatment of agranulocytosis or neutropenia in patients on clozapine therapy, a rare yet serious scenario that clinicians may encounter. We delve into the possibility of rechallenging clozapine treatment after such an event and explore the use of colony-stimulating factors. What's the likelihood of agranulocytosis while prescribing clozapine long term? Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 53 The Impact of Colony-Stimulating Factor on Clozapine Rechallenge Outcomes

Explore how to mitigate, monitor for, and establish clinically relevant thresholds of clozapine-associated inflammation. Access full text of the manuscript at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2887

Caitlin Schanz, PharmD discusses considerations for clozapine-induced myocarditis. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes. You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

In this episode, we discuss the causes of clozapine-induced orthostasis. Although some patients may develop tolerance, it can limit titration and potentially obstruct patients from reaching the plasma level where they respond well to the medication. There are practical management strategies for orthostasis, including slow titration based on patient complaints and encouraging fluid intake, among others. Faculty: Jonathan Meyer, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Managing Some Unique Nonhematologic Adverse Effects of Clozapine Managing Clozapine-Related Orthostasis

In this episode, we explore a common yet severe side effect of clozapine: Constipation. Why does this drug cause such drastic changes in colonic transit times, and how can we manage it effectively? Faculty: Jonathan Meyer, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Managing Some Unique Nonhematologic Adverse Effects of Clozapine Managing Clozapine-Related Constipation

My favorite opening line of an academic article (this week) follows:Mental illnesses are prevalent, cause great suffering, and are burdensome to society.Welcome to the Frontier Psychiatrists. It's a newsletter that I write all by myself. I'm doing a series on medications, largely (but not entirely) in psychiatry. I'm a child and adult psychiatrist, and I still see patients. I've also been a patient since I was 16 years old. Please consider subscribing and sharing widely.The first antipsychotic introduced after clozapine would be a big deal—especially if it didn't cause life-threatening side effects. Risperidone was first developed by the Johnson & Johnson subsidiary Janssen-Cilag between 1988 and 1992 and was first approved by the FDA in 1994. It's one of the very few drugs with data for bipolar disorder that I, personally, have never been prescribed.Risperidone—Risperdal as a trade name—was ready to be a huge hit.It was presented as very atypical—this was the post-clozapine branding of choice. The “second generation” label was added years later. I have a confession to make. After residency, when the attending doctors told me, as a trainee, what to prescribe, I never prescribed risperidone ever again. I think this compound—and paliperidone, the metabolite— still has an important role in managing schizophrenia and bipolar disorder. There are more formulations of long-acting injectable risperidone and related compounds than I can remember. I think those are going to be useful drugs for a long time. Oral risperidone? Nope.Clozapine was an exciting drug. No horrible motor side effects? (Plausibly) More effective? It was better than every drug that came before. It had this pesky adverse effect that could lead to death called agranulocytosis, which I addressed in my first research paper in 2011. We needed more drugs that were this atypical!We—the field of psychiatry, at least— needed things that were not gonna kill you abruptly, in a terrifying manner, like clozapine had the rare potential to do. But we didn't want more of the same old antipsychotics. After Psychiatry got a taste of not having to explain permanent tardive dyskinesia as a likely side effect of antipsychotic medication, we wanted to keep doing that. Editors note: It is still a side effect of all non-clozapine antipsychotics, and we should never have let our guard down.Risperidone was the first antipsychotic that came to market after clozapine rocked the world of psychiatry by being better. Risperidone is similar, and they even use the accidental branding of clozapine— “atypical”—for this medication. The Food and Drug Administration (FDA)-approved indications for oral risperidone (tablets, oral solution, and M-TABs) include the treatment of:* schizophrenia (in adults and children aged 13 and up), * bipolar I acute manic or mixed episodes as monotherapy (in adults and children aged 10 and up), * bipolar I acute manic or mixed episodes adjunctive with lithium or valproate (in adults)* autism-associated irritability (in children aged 5 and up). Also, the long-acting risperidone injection has been approved for the use of schizophrenia and maintenance of bipolar disorder (as monotherapy or adjunctive to valproate or lithium) in adults.The “mechanism of action” of all of the drugs that have efficacy in psychosis was presumed to be dopamine D2 receptor blockade, a mechanism shared with all of the prior medication from Thorazine (chlorpromazine) through Haldol (haloperidol). The assumption—which clozapine disproved—was motor side effects were required for the drug's efficacy in psychosis. This primacy of the D2 blockade as a mechanism of action has since been disproven. This is the mechanism that leads to gynecomastia, leading to a bevy of lawsuits from men who developed breasts. It also causes related side effects like galactorrhea—breast milk from breasts that can be on men or women who are not nursing— and erectile dysfunction. Dopamine—it does a lot of work in the brain, not just pleasure.This motor side effect profile was not true with clozapine. It had various additional receptors, particularly in the serotonergic family (5HT-2a, for example), and alpha-adrenergic, histaminic, and other receptor sites throughout the brain. This broad profile of different receptors explains the wide range of side effects. But more importantly, these are complex, “messy,” and hard-to-predict outcomes given the complexity of the brain. The complex pharmacology allowed psychiatrists like me to think—hard!—about which particular witches brew of receptors we would choose to tickle (agonize) or antagonize. It's very satisfying. I also suspect this is a story we tell ourselves that is not as closely moored to truth as we'd like. We enjoy thinking about science-ish stuff. Receptor binding profiles are seductive— because they are knowable. Our patient's heart, hope, dreams, and heartbreak? Less so.The most important feature of risperidone today—and its 1st order metabolite, paliperidone—is that is deliverable as pills, rapid-acting dissolvable tablets, and long-acting injectable formulations, lasting between 2 weeks and 6 months between doses. A psychiatric treatment that isn't an oral once-daily pill? One you have to take twice a year? Medicine that is intended for people who often—like many—feel conflicted about taking a daily pill? That is a big enough deal. That is a real innovation— it considers human frailty, ambivalence, and common failures of mind. Not because it's a magic drug. Rather, long-acting medicine that doesn't make crippling relapse easy —thanks to good design— is exactly the kind of medicine that works. My second research effort was on the acceptability of such medicines in youth. It's responsible for my presence at the academic conference where I met my now wife.Oral medicines were popular because they were easy to sell. Novel medicines and technologies will be easy to take. The story of my fascination with the risks and benefits of these medicines doesn't end there, though.I still research these medicines and their adverse effects— funded by NIMH— for identifying Tardive Dyskinesia with Machine Learning and closed-loop Internet of Things physical medication compliance tech with my team at iRxReminder and colleagues at Videra. We are enrolling in a study at Fermata in New York and other sites. Thanks for reading.This article is another in my series about one drug or another. Prior installments include Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.Sponsored Content!One way of supporting this publication is buying stuff from Amazon, like a nifty box from Apogee that I used to record the voice-over: the BOOM. In fairness, it's just the A/D. I am also using the API 512c mic pre, plugged into an AnaMod 660 500 series compressor, nestled in a reliable RND R6 Lunchbox, and all of that plugs into the Boom into my Mac. It's a Microtech Geffel mic. Most of the audio post-processing is done with Izotope RX 10. I get money if you purchase any of these things— not a trivial amount since they upped my affiliate rewards.In case anyone was wondering if I was an audio nerd… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Speaker: Robert O. Cotes, MD Associate Professor at Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences Director Clinical & Research Program for Psychosis at Grady Health System Title: Psychiatry Grand Rounds: From Red Tape to Recovery: How You Can Unlock Clozapine's Game-Changing Potential Disclosures: Grant/Research Support: Otsuka, Roche, Alkermes, Karuna Consultant: Saladax Biomedical, HLS Therapeutics (unpaid) Speakers bureau: Saldax Biomedical Objectives: - List three scenarios for when to obtain TDM for clozapine as per the ASCP/AGNP guideline - List one clinically relevant example of how someone from a specific ethnic or cultural background may metabolize clozapine differently - Describe one possible change the FDA could make to the Clozapine REMS system to improve access

In this episode, we delve into the problem of sialorrhea or excessive salivation in patients on clozapine. Why does this occur, and how can it be managed? Join us as Dr. Jonathan Meyer shares his expertise on this unique side effect. Faculty: Jonathan Meyer, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Managing Some Unique Nonhematologic Adverse Effects of Clozapine Managing Clozapine-Related Sialorrhea

Clozapine is an important drug in the treatment of schizophrenia, and adherence is generally thought to be as good as, if not better than, other antipsychotics. Nonadherence, however, is difficult to detect and potentially dangerous. Tolerance to the cardiovascular effects of the drug is easily lost; restarting at a “normal” dose can prove fatal after a period of abstinence. Nonadherence also increases the risk of self-harm. In this podcast, Dr. Robert Flanagan, a now-retired clinical scientist at Kings College Hospital in London, discusses his study of nonadherence, as measured by plasma levels of clozapine, in samples submitted to a clozapine therapeutic drug monitoring service from 1993–2017. In thousands of submitted samples, nonadherence was 1.1% for men and 1% for women. Dr. Flanagan discusses both the implications of his research as well its limits. The research is published in the September–October 2023 issue of the Journal of Clinical Psychopharmacology, in an article titled “Assessing Adherence to Clozapine: Practical Considerations.” Dr. Flanagan's coauthors are Samora Hunter and Stephen J. Obee, also of Kings College Hospital.

In this episode, we welcome Dr. John M. Kane, Dr. Lauren Hanna, Dr. Julia Tartaglia, and Dr. Joseph Flaxer to discuss Clozapine and treatment-resistant schizophrenia. 

Jonathan Leung, PharmD, BCPS, BCPP provides updates on the clozapine REMS program, reviews the therapeutic benefits of clozapine, as well as key adverse events.   For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes. You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Drs John M. Kane and Jonathan Meyer discuss treatment-resistant schizophrenia, how common it is, how to detect and manage it, and how delays in the initiation of treatment negatively affect patients. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984480). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources The Clozapine Handbook: Stahl's Handbooks (Stahl's Essential Psychopharmacology Handbooks) https://www.amazon.com/Clozapine-Handbook-Handbooks-Essential-Psychopharmacology/dp/1108447465 Treatment Resistant Schizophrenia: Clinical, Biological, and Therapeutic Perspectives https://pubmed.ncbi.nlm.nih.gov/30170114/ Predictors of Treatment-Resistant and Clozapine-Resistant Schizophrenia: A 12-Year Follow-up Study of First-Episode Schizophrenia-Spectrum Disorders https://pubmed.ncbi.nlm.nih.gov/33043960/ Mortality in People With Schizophrenia: A Systematic Review and Meta-analysis of Relative Risk and Aggravating or Attenuating Factors https://pubmed.ncbi.nlm.nih.gov/35524619/ Pharmacological Interventions for Clozapine-Induced Hypersalivation https://pubmed.ncbi.nlm.nih.gov/18646130/ The Effect of Clozapine on Premature Mortality: An Assessment of Clinical Monitoring and Other Potential Confounders https://pubmed.ncbi.nlm.nih.gov/25154620/ Antipsychotic Plasma Levels in the Assessment of Poor Treatment Response in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29072776/ Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology https://pubmed.ncbi.nlm.nih.gov/27919182/ An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels https://pubmed.ncbi.nlm.nih.gov/34911124/ FDA Strengthens Warning That Untreated Constipation Caused by Schizophrenia Medicine Clozapine (Clozaril) Can Lead to Serious Bowel Problems https://www.fda.gov/drugs/drug-safety-and-availability/fda-strengthens-warning-untreated-constipation-caused-schizophrenia-medicine-clozapine-clozaril-can Cariprazine https://reference.medscape.com/drug/vraylar-cariprazine-999874 Lumateperone https://reference.medscape.com/drug/caplyta-lumateperone-1000316 Lurasidone https://reference.medscape.com/drug/latuda-lurasidone-999605

Clozapine is a unique antipsychotic with superior efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, approximately 40% to 70% of patients on clozapine continue to experience psychotic symptoms. Nevertheless, there is a concern about how high of a dose to prescribe because adverse effects are related to plasma levels of the drug. In this podcast, Dr. Jan Bogers discusses his research involving stepwise increases in clozapine doses in severely ill, long-stay patients with TRS. The study, conducted at Rivierduinen Mental Health Organization in the Netherlands, concludes that most patients older than 60 years could not tolerate high clozapine levels and so this should not be attempted in older or otherwise physically vulnerable patients. Increasing clozapine levels to approximately 750 ng/mL in middle-aged patients with longstanding TRS may modestly reduce the severity of positive symptoms and improve the response rate. The article appears in the March-April 2023 issue of the Journal of Clinical Psychopharmacology.

CardioNerds co-founder Daniel Ambinder joins Dr. Essa Hariri, Dr. Anna Scandinaro, Dr. Beka Bekhdatze, and Dr. Ashley Kasper (Cleveland Clinic cardiology fellows) as well as Dr. Craig Parris from Ohio State University Medical Center for a walk at Edgewater Park in Cleveland, Ohio. Dr. Andrew Higgins (Crtitical Care Cardiology and Advanced HF / Transplant Cardiology at Cleveland Clinic) provides the ECPR for this episode. They discuss the following case involving a rare cause of non-ischemic cardiomyopathy. A young African American male was admitted for cardiogenic shock following an admission a month earlier for treatment resistant psychosis. He was diagnosed with medication-induced non-ischemic cardiomyopathy, which resolved with a remarkable recovery of his systolic function after discontinuation of the culprit medication, Clozapine. Episode notes were drafted by Dr. Essa Hariri. Audio editing by CardioNerds Academy Intern, student doctor Shivani Reddy. Enjoy this case report co-published in US Cardiology Review: Clozapine-induced Cardiomyopathy: A Case Report CardioNerds is collaborating with Radcliffe Cardiology and US Cardiology Review journal (USC) for a ‘call for cases', with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ). CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - An Unusual Case of Non-ischemic Cardiomyopathy The diagnosis of drug-induced non-ischemic cardiomyopathy is usually one of exclusion. High clinical suspicion is needed to diagnose drug-induced cardiomyopathy. Missing the culprit medication causing drug-induced cardiomyopathy could be detrimental as there is a high probability of reversing a systolic dysfunction after stopping the offending medication. Clozapine is an effective medication for the treatment-resistant schizophrenia and is associated with reduced suicide risk. Clozapine is reported to cause drug-induced cardiomyopathy and is more common with rapid drug titration. Clozapine is more commonly associated with myocarditis. Close monitoring and vigilance are critical to preventing cardiac complications associated with initiating clozapine. The management of clozapine-associated cardiomyopathy includes clozapine cessation and heart failure guideline-directed medical therapy. Show Notes - An Unusual Case of Non-ischemic Cardiomyopathy We treated a case of clozapine-associated cardiomyopathy presenting in cardiogenic shock. Drug-induced cardiomyopathy is a common yet under-recognized etiology of non-ischemic cardiomyopathy. Clozapine is an FDA-approved atypical antipsychotic medication frequently prescribed for treatment-resistant schizophrenia and the only antipsychotic agent that has been proven to significantly reduce suicide among this patient population. However, Clozapine is reported to be associated with several forms of cardiotoxicity, including myocarditis (most common), subclinical clozapine associated cardiotoxicity, and least commonly, drug-induced cardiomyopathy. Clozapine-associated cardiomyopathy should be considered as a differential diagnosis in schizophrenic patients presenting with signs of acute heart failure.  Rapid titration of clozapine is a risk factor for clozapine-associated cardiomyopathy and clozapine-associated myocarditis. To date, there is no evidence or consensus supporting preemptive screening. According to the American Psychiatric Association, whenever clozapine-induced myocarditis or cardiomyopathy is suspected, a cardiology consult is warranted. Experts recommend, when initiating clozapine,

Clozapine is a antipsychotic drug that has been marketed for decades. In this interview, Dr. Friedman shares his thoughts on its utility in Parkinson's disease along with some practical advices on how to use it in the clinic. Read the article.

Should we start prescribing metformin to our patients on clozapine? In this episode, we discuss several articles on the efficacy of clozapine in preventing clozapine-induced weight gain, including some evidence on when metformin is more effective. Faculty: Jim Phelps, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 42 Metformin for the Prevention of Clozapine-Induced Weight Gain: A Retrospective Naturalistic Cohort Study

Like any prescription medication, Abilify, Risperdal, Clozapine, and other anti-psychotics have side effects. And like any medication, they are prescribed to help a person manage an illness. Anti-psychotics can help with a number of different illnesses, but often used to help manage a person's symptoms of schizophrenia, including paranoia, delusions and hallucinations. However, there's a movement that wants to shift mainstream thinking away from using medication to manage the symptoms of a serious mental illness. It's encouraging people to accept and live with the symptoms of serious mental illness, symptoms like voices, hallucinations, and other symptoms. It's a controversial topic and we've brought back a familiar voice from our first season – Dr. Diane McIntosh, Psychiatrist and Clinical Assistant Professor at the University of British Columbia. In this episode, we talk about the use of medications in treating serious mental illnesses like schizophrenia. Resources:Dr. Diane McIntosh - BioBlindsided - Dr. Diane McIntosh's podcastAntipsychotic Selection Is Important for Reduced Nonadherence in SchizophreniaLook Again Season 1, Episode 5: The Truth Behind Psychiatric MedicationAnti-Psychotic Medication - CAMHSee omnystudio.com/listener for privacy information.

Why is clozapine underutilized, even though it's a very effective antipsychotic for treatment-resistant schizophrenia? What led you to write The Clozapine Handbook? In this episode, Dr. Andrew Cutler interviews Dr. Jonathan Meyer about the use of clozapine in clinical practice.  With this special series, brought to you by the NEI Podcast we will address a different theme in psychopharmacology every 3 months. Each theme is split into 3 parts, with one part released each month. This theme is on practical psychopharmacology. Episodes to be released under this theme include: Part 1: Management of Complex Treatment-Resistant Psychotic Disorders with Dr. Michael Cummings Part 2: The Clozapine Handbook with Dr. Jonathan Meyer Part 3: Don't Guess! Measure: The Clinical Use of Antipsychotic Plasma Levels with Dr. Jonathan Meyer Subscribe to the NEI Podcast, so that you don't miss another episode!

USPSTF recommendations on estrogen and progesterone; semaglutide assessed in obese teenagers; efficacy and safety data released for maternal RSV vaccine; updates to clozapine REMS; FDA panel vote on investigational CNS/leptomeningeal metastasis treatment.

How to titrate clozapine in inpatients and outpatients? In this episode, we discuss important considerations for switching to clozapine, including the indications and clinical scenarios for using it. This episode also explains precautions while titrating clozapine and how to reduce the preswitch antipsychotic.  Faculty: Brian Miller, M.D.  Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Antipsychotic Switching: Intersection of Art and Science Important Considerations for Switching to Clozapine

Why do patients stop clozapine?  This episode discusses clozapine discontinuation rates and reasons for doing so among patients who later recommenced clozapine therapy.  Faculty: Jim Phelps, M.D.  Host: Jessica Diaz, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 38 Demographic and Clinical Characteristics of Patients Who Recommence Clozapine Following Therapy Interruptions

This episode discusses whether clozapine and other medications can reduce the risk of suicide. Is it a "class effect" of antipsychotics, or is it specific to clozapine?  Faculty: Jim Phelps, M.D.  Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 33 Effects on Suicidal Risk: Comparison of Clozapine to Other Newer Medicines Indicated to Treat Schizophrenia or Bipolar Disorder

When should you suspect clozapine-induced myocarditis? Myocarditis has nonspecific manifestations. In this episode, Dr. Phelps explains the clinical presentation and the steps to take if you suspect myocarditis. Faculty: Jim Phelps, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 32 Clozapine-Induced Myocarditis: Electronic Health Register Analysis of Incidence, Timing, Clinical Markers, and Diagnostic Accuracy