Virtually all antipsychotic drugs share challenging withdrawal phenomena, which can be even more pronounced in Clozaril tapering, weaning, and titration. These difficulties are most apparent where it is not done correctly.
Clozaril tapering treatment must be done using attentive medical oversight, and adequate support — in other words, the kind of treatment provided at Alternative to Meds Center.
Do Your Symptoms
Alternative to Meds has been helping people with antipsychotic tapering for over 15 years. We invite you to review our published evidence of our successful programs. Addressing underlying root causes does not and should not have to involve toxic treatments. In fact, we have found that frequently there were either missed medical conditions or other overlooked factors that contributed to the crisis. Moreover, these could have since greatly shifted. So, a person may have been following treatment protocols that were unable to fix what was wrong because symptoms had been possibly misdiagnosed or misidentified in the first place.
15 Years Experience by Professionals Who Understand Your Journey.
Clozaril tapering (generic name clozapine) has been studied for over 2 decades, and it has been shown that Clozaril is particularly subject to dramatic withdrawal phenomena, especially in comparison to some other antipsychotic medications.1
The particular risks associated with Clozaril have resulted in strict regulations for the prescribing of Clozaril called REMS, or the Clozaril Risk Evaluation and Mitigation Strategy program, due to potential adverse drug effects such as cancers, seizures, heart damage, and others.16,34
The inherent risks of antipsychotic medication and the process of Clozaril tapering, may at first seem daunting. This can be especially true for those who have experienced or witnessed the damage that mishandling these medications can inflict. Virtually all drugs carry risks. However, antipsychotic medications historically provide perhaps the most alarming and wide range of glaring examples of the double jeopardy of not just taking them, but trying to get off them. Each of these processes can be challenging, to say the least. We have refined our programs to respect these important elements in treatment.
Tapering Guidelines for Safe Clozaril Tapering
The bullet points below are expanded further in this article. It is important to realize that antipsychotics are considered to be one of the most arduous of all drug classes to taper, so please share this information with your caregiver. The information here is not intended to be acted on without support and medical oversight.
It is our stance at Alternative to Meds Center that unsupported Clozaril tapering done without proper oversight and support is highly likely to go off the rails and should not be attempted.
Clozaril Tapering Guidelines include:
Begin your taper when you are stable. This would mean sleeping well, eating well, and not experiencing episodes of anger, rage, or compulsive or unmanageable behaviors.
Part of the preparatory steps to seriously consider would be putting in place a “Ulysses contract” for safety. This is like making a pact with someone you trust and who is willing to help you if you become resistive or noncompliant, such as a family member or close associate. Consider this assurance for your own peace of mind and that of the loved ones around you.8,15
Arrange to work with a prescriber who is familiar with antipsychotic withdrawal phenomena, and who is sympathetic to your situation and willing to assist.
Caffeine or other stimulants should be totally restricted.7,8,20
Also restrict stimulating or repetitive music, television, or even stimulating religious material or the like, which may contribute to over-excitement associated with surging dopamine levels as the drug is weaned.14
Restrict the use of recreational marijuana.9,10,17,18,19
Regular protein-based breakfast daily can help balance blood sugar along with frequent meals (but avoid sugars/refined carbs/glutamate/MSG) throughout the day.11,12,25, 28
Regular cardio exercise is physiologically therapeutic.13,33
Ask your doctor for the lowest dose (25mg pill) or oral liquid version of Clozaril available to help configure lower dosages during the taper. The pills may need to be cut, so ask your doctor to assist for accuracy.
IMPORTANT: Advise your prescriber of any other medications you are also on to avoid unexpected drug interactions. The PDR published over 60,000 words on dangerous drug interactions between clozapine and benzodiazepines, opioids, antidepressants, and hundreds of other drugs, particularly noted for heart issues, seizures, and additive sedative effects that could be life-threatening.34
Based on our own observations at the center, one can expect the taper to last at least 1 month for every year on Clozaril.
Your prescriber can advise you on how much to reduce the medication and how long to wait between cuts. These adjustments need to be correlated to the intensity, duration, or frequency of withdrawal symptoms, as well as how long you have been taking Clozaril so discuss your reactions with your doctor. As reported in the American Journal of Medicine, there are no published guidelines for antipsychotic medication withdrawal so it is important to work with your caregiver to design the plan that works best for you.27
It is reasonable to expect to experience withdrawal symptoms even during a slow tapering process, and these can be helpful signposts to slow down further. Keep a log of details such as when they occurred, duration, intensity, etc., to discuss with your prescriber so that incremental adjustments can be made as timely and accurately as possible.21
Suddenly not sleeping or eating are red flags. Discuss any such changes with your doctor.
Do not expect the end of the taper to go fast. At Alternative to Meds, we have observed generally that the last cuts may be the most challenging.
The FDA stipulates that Clozapine withdrawal must be followed up by closely monitoring white blood cell counts. Discuss and plan for this process with your prescriber.16
Optional: Talk with your prescriber about possibly using bridge medications if needed to get through a point of impasse, such as Depakote.
Diet and Nutrition During Clozaril Tapering
Diet and nutrition are powerful healing tools and can be extremely useful during antipsychotic tapering. Stick to a number of small meals over the day that supply adequate protein to keep blood sugar level. Regular protein-based breakfast is a good start to the day as well. Keep the refined carbs and white sugar and flour products to a minimum and use an organic, whole foods meal and snack plan that doesn’t contain glutamates or other chemicals that can be neurotoxic.11,12,24,25,28
Contracting For Safety
During antipsychotic withdrawal, it is not uncommon for feelings of exuberance, newfound freedom, and resistance to following instructions to emerge, particularly if the taper has progressed too quickly. A super-surge of dopamine could make taking disciplined, controlled steps forward extremely difficult. Abruptly stopping the medication, even if it seems like the most logical thing you should do, could have dire consequences.8 Putting a contract for your own safety (sometimes called a Ulysses contract) in writing, signing it, and giving it to your trusted caregiver or family member before the tapering begins is a simple but effective strategy to help keep things on track. The agreement might stipulate that if you suddenly become unwilling to follow the doctor’s advice, or become bent on booking a midnight flight to Tibet, etc., you would have agreed to hospitalization or other measures to compensate and keep you safe until you can stabilize and resume the taper. Consider this an option that will help ensure your success in the long run.15,21
Restrict Stimulants and Recreational Use of Marijuana
Research is ongoing concerning psychosis associated with marijuana use. One study on animals published in the British Journal of Medicine observes that regular cannabis use depletes levels of a brain lipid called anandamide. When anandamide levels are low, the risk of persisting symptoms of psychosis increases. This would suggest that continuing marijuana use would not be recommended for a person recovering from symptoms of psychosis.9.10.17
For some time research suggested that some marijuana smokers may have certain genetic variants in their profile that likely play a role in dopamine release and dysregulation, which increases the risk of psychosis.18 Other studies have now confirmed this effect according to Di Forti et al in their report on 489 first-episode psychosis patients compared with 278 control subjects.18,19
Stimulants can also induce psychosis, including amphetamines, ADHD drugs, and even caffeine. Caffeine is normally associated with coffee consumption but is also a component of over-the-counter aspirin and other analgesics. Caffeine reduces clozapine metabolism by 14%. Avoid these and other types of stimulants during a Clozaril taper, as the effects will magnify opening up the dopamine floodgates and this is why the taper must be very slow and controlled. Adding stimulants to the mix will unnecessarily set a person up for a disaster.20,34
Reasons to Consider Safe Clozaril Tapering
As far back as 1973, we have researchers disclosing the brain damage caused by the class of drugs known as antipsychotic medications. In one example, the Menninger Clinic case, reports showed that a patient died from damage as a result of participating in an antipsychotic drug trial. The family was awarded millions of dollars as compensation in the court case. As a result, the clinic was fined, and that particular medication never received FDA approval.2 Antipsychotic drugs are well known for unpredictable side effects and concerns have been raised about their long-term effect vs benefit ratio for some individuals, who may in fact do better off antipsychotics than continuing on them for the rest of their life.6
For guidance, we also can look at research that delineates the outcomes of long-term antipsychotic treatment compared with the benefits of short-term antipsychotic treatment.29,30,31,32
Concern over Side Effects of Antipsychotics such as Clozaril
Drug-induced conditions like TD (tardive dyskinesia) and tardive dystonia, are linked directly to antipsychotic medications. And, the risk increases, according to published research,3 according to how long they were taken and at what dosage. TD (repetitive spasmodic involuntary muscle motion or painful twisting and contortions of the muscles) is almost always incurable once it develops. Tardive means slow or late-onset, pointing to the risk for development that increases with the length of time taking antipsychotic drugs such as Clozaril, Zyprexa, Abilify, and many many others.
Perhaps chilling to realize is that antipsychotic drug makers have consistently ranked in the top 10 for lawsuits relating to brain injury or death, as shown in statistics from 2004 through 2012. The fines meted out to these drugmakers are mountainous. Fines in the US alone amounted to $10 billion during this 8-year period,
To compare, Perdue was fined a relative pittance of $600 million in lawsuits due to the infamous tsunami of OxyContin injury and death cases. In the news media, the opiate crisis receives near-constant mainstream air time, (not a criticism), but the antipsychotic drug crisis receives comparative silence. Little to no coverage whatsoever. Currently, it is reported that 500,000 US citizens suffer from drug-induced tardive dyskinesia/dystonia. These conditions are only ever drug-induced and have no other cause than antipsychotic medications.4,5,6
Do Antipsychotic Medications Stop Working Over Time?
Yes over time, antipsychotic medications can become less able to suppress symptoms. These can include psychosis, schizophrenia, or major depressive episodes of Bipolar conditions. Unfortunately, when the drug stops being effective at dampening symptoms, a person’s original psychosis or other symptomology or mania may begin to surface again. This is not surprising — as effective as they are at dampening psychosis and other undesirable symptoms, antipsychotic medications are rarely thought of as curative.5,6
What can also happen over time is that drug side effects can begin to intensify. Antipsychotics such as Clozaril cause a pretty long list of side effects. Some of these may be more intense than others, just as some persons may be more sensitive than others to certain sensations, aches, pains, etc. Side effects can include restlessness, tremor, stiffness, and other physical sensations. Emotional side effects also occur such as emotional blunting. This is where the person feels no joy or satisfaction or reward in life. Others can include a racing heartbeat, dizziness, akathisia, dry mouth, nausea, lack of appetite, drowsiness, low blood pressure, incontinence, and a host of other undesirable reactions. There are some rare but quite severe side effects that Clozaril can cause such as seizures, life-threatening allergic reactions, sudden cardiac death, strokes, and NMS. Neuroleptic malignant syndrome carries the risk of death and like TD is a drug-induced (neuroleptic means drug-induced) life-threatening condition. The symptoms of NMS to watch for are sudden fever, sweating, confusion, muscle rigidity, and rapid breathing. If not treated immediately this condition can lead to death. Originally it was thought that only 1st generation antipsychotics produced symptoms of NMS but further research has shown that 2nd generation antipsychotics can also put a person at risk of NMS and similar conditions.22,23
It may be helpful for a person to discuss with a trusted health advisor or caregiver the benefit-risk ratio of continuing to take a drug that no longer suppresses their original symptoms. This is especially pertinent where the drug is causing or could cause additional discomforts or risks to health from the side effects, such as are listed in the multiple black box warnings on Clozaril package inserts.16, 26
A well-planned. individually tailored holistic-based path of treatment may be a more effective choice over neuroleptic-based treatment, especially over the long term. Holistic treatments can include many therapies to help a person regain their abilities to reduce stress, comfortably socialize, interact with others in a safe and welcoming setting, increase coping skills, learn skills to manage their life well, as well as physical and emotional therapies to address and ease troubles whether mental, emotional or physical in nature.
To reduce or eliminate antipsychotics safely provides a very good first step to becoming free of the burden of pharmaceutical drugs. Then one can begin exploring non-drug-based mental health solutions (one example is orthomolecular medicine). These holistic treatments may be much more productive when the toxicity and medication issues have been reduced or eventually eliminated totally. A gentle, gradual transition is the best way to achieve natural mental health.
Alternative to Meds Center Provides Tools to Improve Natural Mental Health
Alternative to Meds Center has been providing inpatient natural mental health services for over 15 years now with tremendous success. A wide variety of adjunctive therapies include the practice of clearing out the neurotoxic body burden. Even this single step can deliver profound change and confidence toward very tangible improvements in healthy neurochemistry. You can learn more about the amazing array of services provided inpatient for Clozaril tapering in our beautiful and accommodating facility. We are here, more than 40 qualified staff, to help you achieve your mental health goals.
Please contact us at the center for more information concerning our compassionate and welcoming inpatient Clozaril tapering program, get your insurance questions answered, and let us provide you with other hopeful, helpful information for you or for your loved one.
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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