Clozapine is the only medication approved by the US FDA for treatment-resistant schizophrenia and remains highly underutilized for many reasons, including its unique side effect profile and required hematologic monitoring. This presentation will help build prescriber knowledge and confidence by taking a deep dive into clozapine’s pharmacodynamics and pharmacokinetics. Clozapine’s mechanism of action is not fully understood, but its receptor binding affinity differentiates it from other antipsychotics and may provide insights into the complex etiology of schizophrenia. We will review the proposed mechanism of clozapine side effects including neutropenia, myocarditis, sedation, orthostatic hypotension, constipation, and sialorrhea will discuss evidence-based management strategies. Clozapine has the potential to cause clinically relevant drug-drug interactions, which will be highlighted. Finally, we will discuss the value of obtaining clozapine levels and how to interpret them.
Format
Recorded webinar, non-interactive, self-paced distance learning activity with post-test.
This presentation was recorded on July 15, 2021.
Learning Objectives
List two hypotheses for why clozapine has unique efficacy in treatment-resistant schizophrenia.
Compare and contrast the pharmacodynamic properties of clozapine to other antipsychotics.
Explain how clozapine’s mechanism of action at various receptors contribute to its unique side effect profile.
Describe three scenarios where therapeutic drug monitoring for clozapine could be useful.
Outline
- Introduction to Treatment-Resistant Schizophrenia (TRS) and Clozapine
- Clozapine Pharmacokinetics
- Therapeutic Drug Monitoring (TDM) and Clinical Application
- Clozapine Pharmacodynamics and Mechanism of Action
- Management of Clozapine Side Effects
- Conclusion and Clinical Resources
Target Audience
Psychiatrist, Physician (Non-Psychiatric), Physician Assistant, Nurse, Nurse Practitioner, Pharmacist
Instruction Level
Intermediate
Estimated Time to Complete
Estimated Duration: 1.0 hour
Program Start Date: July 30, 2025
Program End Date: July 30, 2028
Ongoing Interdisciplinary Discussion Board
After completing the course, engage with colleagues in the mental health field through the Webinar Roundtable Topics discussion board. This is an easy way to network and share ideas with other clinicians who participate in this webinar. Access through the discussion tab.
How to Earn Credit
After completing the evaluation, participants will have the opportunity to claim their hours of participation and download the appropriate certificate. Physicians may obtain an official CME certificate, other healthcare professionals may receive a CE certificate (as applicable), and all other attendees may generate a certificate of participation. Each certificate will reflect the event date and total hours earned.
Continuing Education Credit
In support of improving patient care, American Psychiatric Association (APA) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
The APA designates this live event for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses/Nurse Practitioners
The American Psychiatric Association (APA) designates this activity for 1.00 Nursing contact hours. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
The American Psychiatric Association adheres to the ACCME's Standards for Integrity and Independence in Accredited Medical Education. Any individuals in a position to control the content of a CME activity - including faculty, planners, reviewers, or others - are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Faculty
- Robert O. Cotes, MD, is an Associate Professor at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. He serves as Co-Director of the PSTAR Clinic (Persistent Symptoms: Treatment, Assessment and Recovery), Director of Project ARROW (Achieving Recovery through Resilience, Optimism, and Wellness) and Co-Director of Open Dialogue Atlanta at Grady's Outpatient Behavioral Health Clinic. The PSTAR Clinic provides evidence-based, recovery-oriented care for individuals with persistent symptoms of psychosis, specializing in the use of clozapine. Project ARROW is a coordinated specialty care team for people experiencing first episode psychosis, offering comprehensive, person-centered care using a multidisciplinary approach. He is a member of the Clinical Expert Team for SMI Adviser. SMI Adviser is a joint initiative of American Psychiatric Association and Substance Abuse and Mental Health Services Administration that provides evidence-based resources to clinicians, individuals with serious mental illness, and their families. Dr. Cotes is an investigator for multiple research studies focused on treatment options for psychosis. His research focuses on clozapine, mitigating cardiometabolic side effects of antipsychotic medications, and first episode psychosis. Dr. Cotes reports no financial relationships with commercial interests.
Program Planners
- Teri Brister, PhD, LPC, National Alliance on Mental Illness. Reports no financial relationships with commercial interests.
- Tristan Gorrindo, MD, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Donna Rolin, PhD, APRN, University of Texas at Austin. Reports no financial relationships with commercial interests.
Accessibility for Participants with Disabilities
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Technical Requirements
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The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
Internet Explorer 11+
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Optimal System Configuration:
Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
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Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content
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