What is the risk associated with clozapine doses greater than 600 mg/day?

Clozapine is an atypical antipsychotic that is particularly effective for treatment-resistant schizophrenia but carries unique safety considerations. Doses greater than 600 mg/day are associated with a significantly higher risk of seizures. This risk is dose-dependent, meaning that the likelihood of experiencing seizures increases as the dose of clozapine increases.

Seizures occur in a dose-dependent manner with clozapine, especially when doses exceed this threshold. Clinicians typically need to monitor patients closely for any signs of seizures at higher doses and may consider strategies to mitigate this risk, including contingent dosing and patient education.

While clozapine does have other risks, such as agranulocytosis and potential prolactin elevation, the most critical concern related to dosing above 600 mg/day is the heightened threat of seizures. Therefore, understanding the implications of clozapine dosing is critical in clinical practice to ensure patient safety, particularly for individuals requiring higher doses for symptom management.