From the FDA Drug Label
2.4 Discontinuation of Treatment Method of treatment discontinuation will vary depending on the patient’s last ANC: Reduce the dose gradually over a period of 1 to 2 weeks if termination of clozapine therapy is planned and there is no evidence of moderate to severe neutropenia
The recommended tapering schedule for discontinuing clozapine (Clozaril) is to reduce the dose gradually over a period of 1 to 2 weeks. 1
From the Research
Tapering off clozapine 50 mg should always be done gradually under close medical supervision, with a recommended approach of reducing the dose by 12.5 mg every 1-2 weeks, as suggested by the most recent and highest quality study 2.
Tapering Schedule
A typical tapering schedule for someone on 50 mg of clozapine might involve:
- Reducing to 37.5 mg for 1-2 weeks
- Then 25 mg for 1-2 weeks
- Then 12.5 mg for 1-2 weeks before stopping completely This schedule may vary based on individual circumstances, such as the patient's medical history, duration of clozapine use, and clinical needs.
Monitoring and Adjustments
During the tapering process, it's essential to monitor for withdrawal symptoms or symptom recurrence, which could include:
- Insomnia
- Anxiety
- Agitation
- Psychosis
- Autonomic symptoms like sweating, nausea, or headaches Regular follow-up appointments are necessary throughout the tapering process to assess mental status and adjust the tapering schedule if needed.
Considerations
Some patients may require a slower taper, especially if they've been on clozapine for a long time. Alternative antipsychotic medication might need to be introduced during the tapering process, depending on the reason for discontinuation and the patient's clinical needs. The study by 2 suggests that a more gradual tapering approach, done over months or years, may minimize the risk of relapse.
Key Points
- Gradual tapering under close medical supervision is crucial to minimize the risk of withdrawal symptoms and relapse.
- Monitoring for withdrawal symptoms and symptom recurrence is essential during the tapering process.
- Individualized tapering schedules may be necessary based on patient-specific factors.
- Alternative antipsychotic medication may be introduced during the tapering process, depending on the patient's clinical needs.