Orthostatic hypotension due to clozapine

Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within 3 minutes of standing compared to the blood pressure from a sitting or supine position. The risk is highest during early clozapine titration, and slow titrations can help to mitigate the risk. Patients can address symptoms by sitting on the edge of the bed for a minute before standing up, and otherwise moving slowly from lying or sitting to standing. Interventions for this side effect include dividing the clozapine dose throughout the day and slowing the dose titration. Increasing fluid and salt intake, or pharmacotherapy using fludrocortisone have also been used.

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