The Clozapine Rechallenge Dilemma: Who, When, and How?

Course Description

Clozapine rechallenge is a complex decision clinicians face in psychiatric care. This session examines the clinical, safety, and ethical considerations involved in restarting clozapine after serious adverse events, like neutropenia or myocarditis. Learners will explore tapering strategies, risk mitigation approaches, and best practices for restarting clozapine safely. Build the knowledge needed to navigate challenging decisions and preserve clozapine’s life-changing benefits.

This is one of seven modules in the A New Era in Clozapine Management educational series. Complete your complimentary registration now to access this module and 6 other ACPE, AMA, ANCC, and AAPA accredited modules.

Return to the main page and view the other modules!

Learning Objectives

  1. Explain reasons for clozapine discontinuation and strategies to mitigate risks.
  2. Discuss evidence-based strategies for tapering and restarting clozapine safely.
  3. Identify clinical scenarios where rechallenging clozapine is appropriate.

Target Audience

We invite you to participate in this online course if you are a pharmacist, physician, nurse practitioner, physician assistant, nurse, or other health care professional involved in the care of individuals with serious mental illness.

Faculty

Robert O. Cotes, MD
View biographical information

Robert O. Cotes, MD | Professor, Emory University School of Medicine

Robert O. Cotes, MD, is a Professor at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences.
Dr. Cotes is Chief of Psychiatry at Grady Health System. He is the founder and Co-Director of the Clinical & Research Program for Psychosis at Grady Health System, which comprises of three clinical programs: 1) PSTAR, which provides evidence-based, recovery-oriented care for individuals with persistent symptoms of psychosis, specializing in the use of clozapine, and 2) Project ARROW, a coordinated specialty care team for people experiencing prodromal and early psychosis, and 3) Youth and Family TREE, a program for youth and young adults with co-occurring disorders. His research focuses on clozapine, pharmacologic and psychosocial interventions for people with schizophrenia, cardiometabolic side effects of antipsychotic medication, and understanding the potential for digital biomarkers in mental health.  He is Editor-In-Chief of Community Mental Health Journal.

Course Requirements

To receive ACPE credit for this session, you must:

  • Register for this course.
  • Complete the pre-test (if applicable) before starting the activity.
  • Review the full content of the activity and reflect upon its teachings.
  • Complete the post-test at the end of the activity no later than the closing activity date.
  • Complete the evaluation at the end of the activity.
  • If necessary, complete the post-test retest no later than the closing activity date.
  • Receive a passing grade (70%).
  • Provide the necessary details in your profile to ensure correct reporting by AAPP to CPE Monitor.

Continuing Education Credit and Disclosures

Activity Dates: 11/3/2025-11/3/2027

Pharmacist ACPE Contact Hours: 0.5
ACPE Number: 0284-9999-25-046-H01-P (Knowledge)

The American Association of Psychiatric Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Jointly Accredited Provider
In support of improving patient care, this activity has been planned and implemented by CME Outfitters, LLC, and American Association of Psychiatric Pharmacists. CME Outfitters is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
  • This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education Credit for learning and change.
  • Physicians (ACCME): CME Outfitters, LLC, designates this internet point-of-care activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • Nurses (ANCC): This activity is designated for 1.0 contact hours.
  • All other healthcare professionals may receive a Certificate of Participation stating this activity was certified for AMA PRA Category 1 Credit™.

At the end of the course, you will be provided with the activity’s evaluation link and print your certificate or statement of credit. Credit request forms, and activity evaluations must be completed online (requires free account activation), and participants can print their certificate or statement of credit immediately. This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit https://www.cmeoutfitters.com/privacy-and-confidentiality-policy

Disclosure Declaration: It is the policy of CME Outfitters, LLC to ensure independence, balance, objectivity, and scientific rigor, and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.  

Faculty for This Clozapine Module:

  • Robert O. Cotes, MD discloses: Consultant – Saladax Biomedical, Clozapine Product Manufacturer’s Group, Boehringer Ingelheim; Research Support – Bristol Myers Squibb, Alkermes, Boehringer Ingelheim; Speakers Bureau – Saladax Biomedical, Clozapine Product Manufacturer’s Group, Boehringer Ingelheim

Planning Committee:

  • Andria F. Church, PharmD, BCPP (AAPP) has nothing to disclose
  • Candice Gillett, MPH (CMEO) has nothing to disclose

Peer Reviewers and Content Reviewers:

  • Content Reviewer (AAPP) - Beth DeJongh, PharmD, FAAPP, BCPP, BCPS has nothing to disclose
  • Content Reviewer (CMEO) - Scott J. Hershman, MD, FACEHP, CHCP has nothing to disclose
  • Peer Reviewer - Kristen Choi, PhD, PMHNP-BC, FAAN has nothing to disclose
  • Peer Reviewer - Chad Koyanagi, MD has nothing to disclose
  • Peer Reviewer - Michael Shuman, PharmD, BCPP has nothing to disclose

 Disclosures were obtained from the CME Outfitters, LLC staff: Nothing to disclose.
*All identified conflicts of interest have been mitigated.


View AAPP's Privacy Policy

AAPP owns the copyright, is licensed or has received permissions for use of, or is otherwise permitted to use copyrighted materials within any CPE activity. Authors and speakers are required to obtain necessary copyright permissions for content in CPE activities. AAPP complies with copyright laws and regulations.

Questions? Contact AAPP.

Unlabeled Use Disclosure: Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CME Outfitters, LLC, the faculty, planners, and American Association of Psychiatric Pharmacists do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use. 

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.

Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by AAPP for any product or manufacturer identified.