Rapid Titration of Clozapine in Schizophrenia and Bipolar Disorder

Despite evidence accumulated over 30 years of clozapine efficacy in schizophrenia, its use is suboptimal. Long duration of standard titration and monitoring procedures are strong barriers in clozapine prescribing. The aim of the present paper is to discuss the challenges of rapid clozapine titration. The currently approved/recommended titration methods in US, Europe, and Australia are discussed. The rapid clozapine titration was introduced in our hospital in the early 2000's as "last resort" method for aggressive, belligerent or homicidal patients with schizophrenia and bipolar disorder. In our opinion, rapid clozapine titration might shorten the duration of patient and family suffering associated with uncontrolled psychotic symptoms, reduce the need and risks associated with polypharmacy, and reduce the costs of health care services of prolonged hospitalization. As there are no randomized controlled clinical trials to compare the efficacy and safety of standard versus rapid titration of clozapine in schizophrenia or bipolar disorder, future studies are needed.