NAMI Ask the Expert: Clozapine: Understanding Benefits & Barriers OD026

An on-demand video and transcript of the presentation are available here [opens in new tab].

About The National Alliance on Mental Illness (NAMI)

The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. They are an alliance of more than 650 local Affiliates and 49 State organizations who work in your community to raise awareness and provide support and education to people with mental illness and their loved ones. Through awareness, advocacy and education, NAMI is committed to building stronger communities and a better future for everyone affected by mental illness.

Course Summary

Practice Level: Intermediate

This course, based on the Ask the Expert webinar series by NAMI, provides a concise, practice-oriented overview of clozapine for treatment-resistant schizophrenia and for reducing suicidal behavior in schizophrenia or schizoaffective disorder. The speaker synthesizes the evidence base on efficacy, common and serious adverse effects, and monitoring requirements—emphasizing practical approaches to titration, bloodwork, and coordination with pharmacies to prevent treatment gaps. Learners will examine barriers to appropriate clozapine use (e.g., prescriber discomfort, logistical hurdles, disparities including benign ethnic neutropenia) and evidence-informed strategies to address them. The session situates clozapine within recovery-oriented care, focusing on outcomes that matter to individuals and families.

The course, with an intended audience of social workers, psychologists, marriage and family therapists, and counselors, then presents current guidelines and consensus recommendations into concrete, interprofessional steps for assessment, shared decision-making, initiation, and ongoing monitoring in routine care.

Course Format

This course contains a participant guide, practice test, and on-demand video.

Learning Objectives

1. Describe eligibility criteria and evidence-based indications for clozapine, including treatment-resistant schizophrenia and suicide-risk reduction.
2. Identify common adverse effects and evidence-supported monitoring strategies for neutropenia and myocarditis.
3. Identify logistical barriers a client may have in accessing clozapine.

Course Syllabus

• Why Clozapine Matters
• Identifying Candidates & Preparing to Start
• Safety & Monitoring
• Implementation & Systems Solutions

Current References

American Association for Community Psychiatry. (n.d.). About SMART (Self-Assessment for Measuring & Addressing Racism Tool).https://www.communitypsychiatry.org/smart-tool [opens in new tab]

Carruthers, J., Radigan, M., Erlich, M. D., Gu, G., Wang, R., Frimpong, E. Y., Essock, S. M., Olfson, M., Castillo, E. G., Miller, G. A., Sederer, L. I., & Stroup, T. S. (2016). An initiative to improve clozapine prescribing in New York state. Psychiatric Services, 67(4), 369–371. https://doi.org/10.1176/appi.ps.201500493 [opens in new tab]

Cotes, R. O., Rolin, D., Meyer, J. M., Young, A. S., Cohen, A. N., & Gorrindo, T. (2021). A survey of personnel and services offered in 32 outpatient US clozapine clinics. BMC Psychiatry, 21, 583. https://doi.org/10.1186/s12888-021-03584-6 [opens in new tab]

CURESZ Foundation. (2026). Clozapine expert panel.https://curesz.org/clozapine-expert-panel/ [opens in new tab]

Gupta, S., Bannon, A., Nodiyal, S., & Sinha, B. (2025). Management of clozapine-associated neutropenia. BJPsych Advances, 31(2), 113–123. https://doi.org/10.1192/bja.2024.51 [opens in new tab]

Jakobsen, M. I., Schaug, J. P., Storebø, O. J., Austin, S. F., Nielsen, J., & Simonsen, E. (2025). What is the current scope of research assessing patients’ and clinicians’ perspectives on clozapine treatment? A comprehensive scoping review. BMJ Open, 15(1), e085956. https://doi.org/10.1136/bmjopen-2024-085956 [opens in new tab]

Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Walaszek, A., Buckley, P., Lenzenweger, M. F., Young, A. S., Degenhardt, A., & Hong, S. H.. (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Psychiatric Association, 177(9), 868–872.https://doi.org/10.1176/appi.ajp.2020.177901 [opens in new tab]

Lind, P. A., Parker, R. K., Northwood, K., Siskind, D. J., & Medland, S. E. (2025). Clozapine efficacy and adverse drug reactions among a nationwide study of 1021 Australians prescribed clozapine: The clozagene study. Schizophrenia Bulletin, 51(2), 458–469. https://doi.org/10.1093/schbul/sbae065 [opens in new tab]

Meltzer, H. Y., Alphs, L., Green, A. I., Altamura, A. C., Anand, R., Bertoldi, A., Bourgeois, M., Chouinard, G., Islam, M. Z., Kane, J., Krishnan, R., Lindenmayer, J.-P., & Potkin, S. (2003). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Archives of General Psychiatry, 60(1), 82–91. https://doi.org/10.1001/archpsyc.60.1.82 [opens in new tab]

Olfson, M., Gerhard, T., Crystal, S., & Stroup, T. S. (2016). Clozapine for schizophrenia: State variation in evidence-based practice. Psychiatric Services, 67(2), 152–154. https://doi.org/10.1176/appi.ps.201500324 [opens in new tab]

Pillinger, T., McCutcheon, R. A., Vano, L., Mizuno, Y., Arumuham, A., Hindley, G., Beck, K., Natesan, S., Efthimiou, O., Cipriani, A., & Howes, O. D. (2020). Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: A systematic review and network meta-analysis. The Lancet Psychiatry, 7(1), 64–77. https://doi.org/10.1016/S2215-0366(19)30416-X [opens in new tab]

Quiles, C., de Leon, J., & Verdoux, H. (2025). Benzodiazepines and clozapine co-prescription in clinical practice: A systematic review and expert recommendations. Expert Opinion on Drug Metabolism & Toxicology, 21(9), 1103–1115. https://doi.org/10.1080/17425255.2025.2548524 [opens in new tab]

Stroup, T. S., Gerhard, T., Crystal, S., Huang, C., & Olfson, M. (2014). Geographic and clinical variation in clozapine use in the United States. Psychiatric Services, 65(2), 186–192. https://doi.org/10.1176/appi.ps.201300180 [opens in new tab]

U.S. Food and Drug Administration. (2025, August 27). FDA removes risk evaluation and mitigation strategy (REMS) program for the antipsychotic drug clozapine.https://www.fda.gov/drugs/drug-safety-and-availability/fda-removes-risk-evaluation-and-mitigation-strategy-rems-program-antipsychotic-drug-clozapine [opens in new tab]

van der Horst, M.Z., de Boer, N., CLOZIN collaborators, Okhuijsen-Pfeifer, C., & Luykx, J. J. (2025).Determinants of patient satisfaction in clozapine users: Results from the Clozapine International Consortium (CLOZIN). Schizophrenia, 11, 28. https://doi.org/10.1038/s41537-025-00570-9 [opens in new tab]

Instructors

Robert O. Cotes, M.D.

Robert O. Cotes, M.D., is an Associate Professor at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. He is Director of the Clinical & Research Program for Psychosis at Grady Health System, which comprises of two clinical programs: 1) PSTAR Clinic (Persistent Symptoms: Treatment, Assessment and Recovery) and 2) Project ARROW (Achieving Recovery through Resilience, Optimism, and Wellness). The PSTAR Clinic provides evidence-based, recovery-oriented care for individuals with persistent symptoms of psychosis, specializing in the use of clozapine. Project ARROW is a coordinated specialty care team for people experiencing first episode psychosis, offering comprehensive, person-centered care using a multidisciplinary approach.

Nicole Errickson, LCSW                                                                                                    

Nicole is a Licensed Clinical Social Worker (LCSW) in the state of Georgia. She brings over 19 years experience in the social work field, primarily working in school systems as a school social worker and with the McKinney-Vento grant. Over her career, Nicole has had several opportunities to help develop and execute professional development events. Nicole has a bachelor’s degree in psychology from the University of South Alabama and a Masters in Social Work from the University of Alabama.

Accreditation Approval Statements

CE4Less.com is approved by the American Psychological Association to sponsor continuing education for psychologists. CE4Less.com maintains responsibility for this program and its content.

CE4Less.com, provider #1115, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 8/8/24-8/8/27.

Social workers completing this course receive 1 general continuing education credits.

We are committed to providing our learners with unbiased information. CE4Less never accepts commercial support and our authors have no significant financial or other conflicts of interest pertaining to the material.