W30 – Using Ethno-Psychopharmacology Concepts for Best Practices in Clozapine Prescribing

W30 – Using Ethno-Psychopharmacology Concepts for Best Practices in Clozapine Prescribing

Saturday, Oct. 21
10:45 – 11:45 (1 hr)
Meeting Room: Beluga (3rd floor – B Tower)
Reza Rafizadeh*, BPharm, ACPR, BCPP; Reza Rafizadeh, BPharm, ACPR, BCPP; Harish Neelakant, MD, FRCPC; Randall White, MD, FRCPC

CanMEDS Roles:

  1. Collaborator
  2. Health Advocate
  3. Medical Expert

At the end of this session, participants will be able to: 1) Perform risk stratification analysis at baseline for personalized dosing of clozapine; 2) Recognize and manage major drug-disease and drug-drug interactions that can contribute to clozapine toxicity; and 3) Describe a model for community-based treatment optimization for patients with complex and chronic psychotic disorders.

Clozapine is the only registered treatment for treatment-resistant schizophrenia (TRS), psychosis in Parkinson disease, and, in the United States, suicidality in schizophrenia and schizoaffective disorder. Lack of adequate training in the initiation and optimization of clozapine treatment is identified as a barrier in systematic reviews on widespread underuse of clozapine. Practitioners have identified difficulty selecting suitable patients, inadequate knowledge or experience in the use of clozapine, fear of side effects, ignorance of clozapine side effects, and unclear guidance on clozapine monitoring as major contributors to poor clozapine prescribing. Underuse of clozapine in BC has long been recognized and, in Vancouver, an effort is underway to increase community clozapine initiation across publicly administered mental health teams. In this workshop, we will describe the creation and implementation of various clinical tools and practice supports for treatment optimization of psychosis. With regard to ethno-pharmacological variations among people with TRS, safer and more individualized prescribing of clozapine is now possible, thanks to advances in our understanding of its pharmacokinetic/dynamic properties. Familiarity with these guidelines for safer clozapine prescribing can help Canadian prescribers gain confidence and promote best practices around initiation and optimization of clozapine treatment. This presentation will illustrate principles of treatment optimization and individualized clozapine prescribing with a combination of evidence review, case reports, and aggregate outcome metrics.


  1. de Leon J, Schoretsanitis G, Smith RL, 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.
  2. Correll CU, Agid O, Crespo-Facorro B, et al. A guideline and checklist for initiating and managing clozapine treatment in patients with treatment-resistant schizophrenia. CNS Drugs 2022;36(7):659–679.