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meds:antipsychotics:second-gen-atypical:7-clozapine [on March 25, 2020]
meds:antipsychotics:second-gen-atypical:7-clozapine [on March 27, 2020]
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 ==== Target Plasma Level ==== ==== Target Plasma Level ====
-The dose of clozapine is not correlated with clinical response, rather, it is the clozapine //plasma level// that matters. The lowest effective clozapine plasma levels range from **250 to 550 µg/L** based on research consensus. Plasma levels below 200 μg/L may place patients at a higher risk of relapse, while above 1000 μg/L increases the risk of developing ​seizures. The recommended upper limit to prevent clozapine toxicity ranges from 600 to 2000 µg/​L. ​The dose of clozapine ​taken does not always correspond to plasma levels. Plasma levels are generally lower in younger patients, males and smokers, while being higher in Asians. Other factors that can change clozapine levels include adherence, inflammation,​ and infection. Clozapine plasma levels correlates with seizure risk. Retrospective studies have been used to create nomograms to help determine whether serum levels are therapeutic based on specific patient demographics, including ​smoking, age, sex, and metabolic activity.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​14709950|Rostami-Hodjegan A, Amin AM, Spencer EP, Lennard MS, Tucker GT, Flanagan RJ. Influence of dose, cigarette smoking, age, sex, and metabolic activity on plasma clozapine concentrations:​ a predictive model and nomograms to aid clozapine dose adjustment and to assess compliance in individual patients. J Clin Psychopharmacol. 2004;​24(1):​70-8.]])]+The dose of clozapine is not correlated with clinical response, rather, it is the clozapine //plasma level// that matters. The lowest effective clozapine plasma levels range from **250 to 550 µg/L** based on research consensus. Plasma levels below 200 μg/L may place patients at a higher risk of relapse, while above 1000 μg/L increases the risk of seizures. The recommended upper limit to prevent clozapine toxicity ranges from 600 to 2000 µg/​L. ​Additionally,​ the dose taken does not always correspond to plasma levels. Plasma levels are generally lower in younger patients, males and smokers, while being higher in Asians. Other factors that can change clozapine levels include adherence, inflammation,​ and infection. Retrospective studies have also been used to create nomograms to help determine whether serum levels are therapeutic based on specific patient demographics ​such as smoking, age, sex, and metabolic activity.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​14709950|Rostami-Hodjegan A, Amin AM, Spencer EP, Lennard MS, Tucker GT, Flanagan RJ. Influence of dose, cigarette smoking, age, sex, and metabolic activity on plasma clozapine concentrations:​ a predictive model and nomograms to aid clozapine dose adjustment and to assess compliance in individual patients. J Clin Psychopharmacol. 2004;​24(1):​70-8.]])]
  
 ==== Hematological Monitoring ==== ==== Hematological Monitoring ====