Clopixene Dosage/Direction for Use

In the treatment of schizophrenia, including reducing the risk of suicidal behaviour, the usual oral dose is 12.5mg once or twice on the first day followed by 25mg once or twice on the second day. Thereafter the daily dosage may be increased gradually in steps of 25 to 50mg to achieve a daily dose of up to 300mg within 14 to 21 days. Subsequent increases in steps of 50 to 100mg may be made once or twice weekly, a daily dosage of 900 mg should not be exceeded. Once a therapeutic response has been obtained, a gradual reduction of dosage to a suitable maintenance dose is recommended, most patients respond to 200 to 450 mg daily. The total daily dose is given in divided doses; a larger portion may be given at night. Daily maintenance doses of 200mg or less may be given as a single dose in the evening. If clozapine is to be withdrawn, this should be done gradually over a 1-to 2 week period. However, immediate withdrawal with careful observation is essential if neutropenia develops or if myocarditis or cardiomyopathy is suspected. Elderly patients may require lower doses of clozapine and it is recommended that treatment should start with a dose of 12.5 mg on the first day and that subsequent dose increments should be restricted to 25 mg.
For patients who are restarting treatment after an interval of more than 2 days, 12.5 mg may be given once or twice on the first day. If this dose is well tolerated it may be possible to increase the dosage more quickly than when first starting. However, patients who have had respiratory or cardiac arrest with initial dosing, but were then successfully titrated to a therapeutic dose, should be re-titrated with extreme caution after a break of even 24 hours. Additional monitoring of blood cell counts may also be required if treatment is interrupted. It is recommended that oral therapy with other antipsychotics should be withdrawn gradually before treatment with clozapine is started.