Titration Settings

Baseline Titration Schedule
Select 0 for new initiation
Max 300mg above current dose

Demographics

Ancestry
Sex
Smoking
Age

PM Criteria

Slows titration & reduces target dose.

General Recommendations

Warnings & Precautions

  • Do not start clozapine with powerful CYP1A2 inhibitors (e.g., fluvoxamine)
  • Slow titration if patient develops orthostatic hypotension, tachycardia, or severe sedation
  • Do not decrease prior antipsychotic(s) until Week 4 or later AND plasma clozapine ≥350 ng/mL

CRP Monitoring

  • Measure CRP at baseline and weekly during the first 4 weeks
  • Abnormal baseline CRP indicates possible infection — do not start until normalized
  • Fever and/or abnormal CRP during titration may indicate clozapine-induced inflammation
  • Do not increase dose until CRP normalizes — continuing may lead to myocarditis
  • Abnormal CRP can also indicate rare (~1%) genetic poor metabolizers

References

Sources:

Teva Clozapine Example Titration Schedule. TevaClozapine.com.

Oxford Health NHS Foundation Trust. Clozapine Outpatient Titration Protocol. Jan 2024.

de Leon J, et al. An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels. Pharmacopsychiatry. 2022;55(2):73-86.

This tool provides general guidance based on published guidelines and should not replace clinical judgment. Always consider individual patient factors and local protocols.