SMI Adviser Clozapine Center of Excellence

Education, resources, and evidence-based answers to help you optimize the use of Clozapine
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Welcome to the Clozapine Center of Excellence (COE)

SMI Adviser established the Clozapine COE to promote the safe and effective use of clozapine. The ultimate goal of this effort is to improve the lives of individuals who have treatment-resistant schizophrenia. The Clozapine COE provides clinicians with training opportunities, technical assistance, and vetted resources. These include:

  • Live and on-demand webinars
  • Virtual Learning Collaboratives
  • Virtual Forums
  • Email listserv
  • On-demand consultations
  • Intensive consultation to sites or communities
  • Clinical tips and resources

The Clozapine COE is led by SMI Adviser Physician Expert, Robert Cotes, MD, SMI Nursing Expert, Donna Rolin, PhD, APRN, and SMI Adviser content partner, National Association of State Mental Health Program Directors (NASMHPD), and supported by members of the Clozapine Workgroup.

For individual and family resources on using clozapine, visit the Individuals and Families Knowledge Base.

  • Resources
  • Education
  • Join Us
  • Consultation
Insomnia, Hyperarousal, and Suicide in Psychosis

Overcoming Barriers and Unlocking Clozapine: A Panel Shares Clinic, System, and State-wide Strategies

Psychiatric Medications in Pregnancy

Learning From Each Other: Reimagining the Role of Medication in Crisis Care

Treating Transitional Age Youth with Clozapine

A Delicate Dance: The Principles and Practice of Deprescribing Antipsychotic Medications

New Clozapine REMS: Staying Informed for the November 15 Changes

Keeping Up with Clozapine REMS: A Guide to Navigating the November 15 Changes

Psychotropic Medications and Older Adults: Update on Safety Considerations

Strategies for Successful Use of Clozapine: A Practical Guide

Maximizing Treatment Success for Patients with SMI: Promoting Adherence and Treatment Engagement

Addressing Barriers to Clozapine Underutilization

Clozapine in the Elderly and Those with Medical Comorbidity, and Care Transitions

Clozapine-Related Adverse Events and Managing Inadequate Response

Clozapine & LAI Virtual Forum

Join us for a live peer-to-peer discussion each month to share your challenges and questions on trending topics around clozapine and LAIs. Sign up for the Clozapine and LAI Centers of Excellence Exchange above to receive invitations.

View Past Recordings

Get Expert Guidance on Questions Around Clozapine

Submit any questions you have on managing side effects, assessment and monitoring, medical comorbidities, and any other topic. Receive a response within one business day from one of our national experts.

Can clozapine cause urinary retention, and if so, what can be done about it?
Is clozapine contraindicated for breastfeeding mothers?
Can clozapine cause blurry vision, and if so what can be done about this?

In an announcement dated November 2, 2022, the FDA will temporarily use their discretion with regards to enforcing (or not enforcing) an additional aspect of REMS, allowing for more flexibility with regards to the REMS program requirements.  To help ensure continuity of care from inpatient to outpatient settings, the FDA no longer objects if inpatient pharmacies dispense a supply of clozapine that aligns with the patient’s historical monitoring frequency.

For example:

  • If the patient has been on weekly monitoring, the pharmacy may dispense a 7-day supply.
  • If the patient is on every other week monitoring, the pharmacy may dispense a 14-day supply.
  • If the patient has been on monthly monitoring, the pharmacy may dispense a 30-day supply.

Additionally, the FDA continues to exercise the enforcement discretion from the November 2021 announcement, which means that the FDA does not intent to object if pharmacists dispense clozapine without a REMS dispense authorization.  See the full announcement here

Trending Topics

Use our Knowledge Base to find evidence-based answers and resources on Clozapine. Here are some popular topics — all vetted by our Clinical Expert Team.

Clozapine REMS Program Updates: A Guide for Prescribers and Pharmacists

This resource was approved by the SMI Adviser clinical expert…

How do I interpret clozapine or norclozapine blood, serum or plasma levels, what do these mean?

Clinician assessment of symptoms and side effects is the primary…

What is Benign Ethnic Neutropenia and does it relate to low clozapine white counts?

Approximately one half of African Americans have neutrophil counts that…

Is weight gain a problem with clozapine, and what can be done?

Significant weight gain can occur in individuals who take clozapine,…

How does one dose or titrate clozapine dosage when starting on this medication?

The dosage of clozapine is titrated up gradually, to minimize…

How should I transition, taper or discontinue an existing antipsychotic medication when starting clozapine?

When starting clozapine, if a patient is taking an antipsychotic…

Clozapine Tachycardia Side Effect

Most people have a resting heart rate between 60 and…

What can clinicians do when individuals have either a partial or no response to clozapine?

Although clozapine has a unique efficacy for individuals with treatment…

Tips on Starting Clozapine


Tips on Monitoring


Tips on Common Side Effects


Tips on Important Uncommon Side Effects


Tips on Challenges


Clozapine Dose Planner


Guidelines and Research


Information and Handouts for Individuals and Families


View Past Recordings


Clozapine & LAI Virtual Forum

Join us for a live peer-to-peer discussion each month to share your challenges and questions on trending topics around clozapine and LAIs. Sign up for the Clozapine and LAI Centers of Excellence Exchange above to receive email invitations.

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