Psychosis during the course of Parkinson's disease

Active Ingredient: Clozapine

Indication for Clozapine

Population group: only adults (18 years old or older)

Clozapine is also indicated in psychotic disorders occurring during the course of Parkinson’s disease, in cases where standard treatment has failed.

For this indication, competent medicine agencies globally authorize below treatments:

12.5-100 mg in 2 divided doses daily

Route of admnistration


Defined daily dose

12.5 - 900 mg

Dosage regimen

From 6.25 To 450 mg 2 time(s) per day every day

Loading dose

12.5 mg

Detailed description

Starting therapy

The starting dose must not exceed 12.5 mg/day, taken in the evening. Subsequent dose increases must be by 12.5 mg increments, with a maximum of two increments a week up to a maximum of 50 mg, a dose that cannot be reached until the end of the second week. The total daily amount should preferably be given as a single dose in the evening.

Therapeutic dose range

The mean effective dose is usually between 25 and 37.5 mg/day. In the event that treatment for at least one week with a dose of 50 mg fails to provide a satisfactory therapeutic response, dosage may be cautiously increased by increments of 12.5 mg/week.

Maximum dose

The dose of 50 mg/day should only be exceeded in exceptional cases, and the maximum dose of 100 mg/day must never be exceeded.

Dose increases should be limited or deferred if orthostatic hypotension, excessive sedation or confusion occurs. Blood pressure should be monitored during the first weeks of treatment.

Maintenance dose

When there has been complete remission of psychotic symptoms for at least 2 weeks, an increase in anti-parkinsonian medication is possible if indicated on the basis of motor status. If this approach results in the recurrence of psychotic symptoms, clozapine dosage may be increased by increments of 12.5 mg/week up to a maximum of 100 mg/day, taken in one or two divided doses (see above).

Ending therapy

A gradual reduction in dose by steps of 12.5 mg over a period of at least one week (preferably two) is recommended.

Treatment must be discontinued immediately in the event of neutropenia or agranulocytosis. In this situation, careful psychiatric monitoring of the patient is essential since symptoms may recur quickly.

Active ingredient


Clozapine has been shown to be an antipsychotic agent that is different from classic antipsychotics. Clozapine has potent anti-alpha-adrenergic, anticholinergic, antihistaminic, and arousal-reaction-inhibiting effects. It has also been shown to possess antiserotoninergic properties.

Read more about Clozapine

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