Patients should recommence clozapine treatment starting from 12.5mg once or twice daily on day 1. The product information for clozapine suggests that re-titration to a previous dose may be achieved at a faster rate than initial titration, if it is safe to do so. The blank clozapine titration chart can be used for this purpose.
The following factors should be considered when deciding how quickly to build up the dose:
- What dose was the patient on previously and for how long? The higher the dose, the longer re-titration will take.
- Did the patient experience any issues during the original titration (e.g. postural hypotension, persistent tachycardia)?
- What caused the treatment break (e.g. intolerable dose-related side effects, physical illness)?
- The setting in which re-titration will take place. Hospital re-titrations may allow faster dose escalation as more intense monitoring is possible. Patients may be discharged prior to the completion of their re-titration if their CMHT can support the necessary monitoring.
If in doubt use the standard clozapine titration chart . This takes the daily dose to 275mg by day 15 and further alterations can be made from there as appropriate.