Clozapine rapid retitration in the community: an assertive approach can prevent admissions. (28th June 2018)

• Record Type: Journal Article
• Authors: Nikolić, Nikola; Kilbride, Kevin; Preston, Patrick
• Is Part Of: BJPsych advances. Volume 25:Number 1(2019)
• Page Start: 70
• Page End: 71
• Publication Date: 2018-06-28
• Subjects: Psychiatry -- Periodicals; 616.89005
• DOI: 10.1192/bja.2018.21
• Languages: English
• ISSNs: 2056-4678

Abstract

SUMMARY: Rapid retitration of clozapine may be necessary to reduce the known high risk of mental state destabilisation in patients who have had a 48 h treatment break. It may carry a high risk of complications, including seizures and myocarditis. We reflect on the literature on standard and rapid retitration and present a case of rapid retitration in the community. In this case, of a 54-year-old homeless man with treatment-resistant schizophrenia and polysubstance misuse, we safely retitrated clozapine in a community setting four times during a 6-month period; each retitration was completed over 4 days. We used a specific protocol based on his psychiatric history. We are now more confident in delivering clozapine retitration to other patients, thus preventing unnecessary admissions. DECLARATION OF INTEREST: N. N. has received honoraria from Janssen Pharmaceuticals.