Maintenance doses for clozapine

Abstract

The British National Formulary (BNF) entry for clozapine clearly distinguishes the treatment dose (200-450 mg daily, maximum 900 mg) from the maintenance dose (150-300 mg daily). We looked at 44 patients maintained on clozapine locally and found that 36 (82%) received doses above the BNF guidelines. This has considerable cost implications. While it is always good practice to maintain patients on the lowest possible dose of antipsychotic, the BNF guidelines are not based on objective outcome data, and should be treated cautiously.