can someone help in answering these questions
is it safe to crush low doseClozapine tablets like 12mg, 25mg, 50mg or 100mg in Coffee and warm it in the coffee cup then drink it.
is it Ok to take low dose of clozapine with 30mg of Zyprexa ( Olanzapine) ?
My best advice as a mom/caretaker of a now adult son with schizophrenia that has successfully been on clozapine for the past 15 years. Don’t make up your own way to take the medications. The results can go terribly wrong and make conditions much worse.
First of all, dosages of clozapine have to be slowly increased or decreased with monitoring by a professional, it’s called titration. The effectiveness of the drug is also reliant upon the steady reliable use of it over a long period of time. It can also be affected to some degree by the amounts of nicotine of caffeine the person consumes daily.
With my son, it took about a year of regulating the dosage and getting his use of coffee and cigarettes to a more reliable amount daily to get him stabilized. All these years later, he is doing very well.
I would not crush any pill unless advised by a doctor. If the goal is for the drug to work on improving symptoms of a mental illness it is essential that the pills are taken exactly when and how the doctor prescribes and long enough for the medication to show its full effects (which can sometimes be months). I can’t stress that enough. Mixing meds should also be directed by a doctor.
Please take this important question you have asked here and ask it with a psychiatrist or a pharmacist and heed their advice for the best outcome. I wish you well.
30 mg of Olanzapine is a pretty high dose in itself and may come with metabolic issues (i.e. weight gain). As @Catherine wrote, everything must be cleared with a psychiatrist.
There is a Facebook group named Team Daniel and the Clozapine Community. Very informative. They have Saturday online group meetings also.
can you please send me information about Team Daniel meeting… how to attend?
my son is med resitant and he got better one time at a hospital setting with medium dose of Invega and 450 mg of Clozapine in 2019. when he transferred to Facility, they dropped the Invaga and he became aggressive and was back to hospital. after several months in the Hospital he was discharged with 7 different meds that was very hard to manage.
he left CALIF and came to stay with me in ARkansas in 2020, he started cutting his meds and he was hospitalized at least 4 times…
Currenlty he is taking Invega high dose + 30 mg Zyprexa but still hearing voices. doctor is thinking to increase Zyprexa by another 10 mg and I told him that I am concerned about the increase and suggested to try clozapine again and drop Zyprexa and he keeps that my son has to approve blood draw and he is refusing.
another issue that my Son keeps on counting how many pills he takes daily and does not want to take more 3 pills at night ( 20mg zyprexa + 2 pill of Lithum) and also he takes low dose of zyprexa at day time.
this is frustrating!! no improvement…
Make sure with the lithium that he gets tested for blood levels. That’s something that needs to be monitored because it can cause kidney damage – as it did with my son. IMO, the lower dose of lithium, the better. There may be alternative bipolar meds that are safer.
You will need to join the group and request a link from the admin to join the meeting on Saturdays.
I am really sorry to hear about the hardship of trying to stabilize your son on the right medications. I went through a whole lot of that at first too. The thing about the clozapine is it doesn’t work immediately; it is a slow and gradual improvement over the course of months. You didn’t mention how long he was allowed to stay on the clozapine. However, going forward, the best I could recommend, is to try to get medical guardianship for your son through the probate court, if possible, which would allow you to make the medical decisions on his behalf (even if he disagrees) including the blood tests needed for the clozapine and allowing you to interact directly with his doctors.
Honestly, my son was skeptical about the blood tests as well, but I had guardianship and pushed the issue and today (after seeing how much better he feels) he is 100% on board with the blood draws each month. It took him getting better to see the good in it. You are correct that it’s extremely frustrating especially given the state of our mental health care (or lack thereof) in the United States. I am here anytime you need to vent. I hope things improve for you and your son.
I do have permanent Guardianship and I had forced him into Hospitalization numerous times between 2015 and 2023 ( at least 15 times).
He is the most stable now in the past 2 years but would not care enough for his Hygene. he only shaves, cuts his hair and brushes his teeth after numerous requests ( I have to ask him many times).
He has been taking the Invega shot 234 mg and The Zyprexa ( 20mg at night and 10mg at day) since April /2024. Before that he was taking medium Shot Invega and Zyprexa.
He is also taking 900mg Lithium at night.
He talks to himself at certain times of the month. The shot manifests at a different level of behavior every 10 days. The first 10 days after taking the shot he is calmer and more relaxed but scared to get out of the house, then the next 10 days he can get a little aggressive and impatient and also scared of getting out of the house. The last 10 days he is calmer and still afraid to get out of the house.
He is refusing to take any Anxiety pill or anti -depressant. He only wants to take the same number of pills ( 3 at night and one at day) and no more.
I consulted with a Doctor overseas about adding a small dose of clozapine like 12 mg then 25mg to his med and asked if that would not harm him? he said it is OK.
I can get the Clozapine from my sister overseas but I am afraid to try it since he is not compliant on blood tests and he would not take the pill. I am also afraid of withdrawal Symptoms. I read that one of Clozapine withdrwal symptoms is Suicidal.
I ask the angry moms if it is OK to crush a small dose of 12mg of clozapine in his coffee because he drinks coffee during the day they refer me to Daniel Recovery website.
I will do more research…
The issue with Hospitalization in my city is that they do not keep him enough to try clozapine.
The last hospital in my Area in 2021, he was there for 5 weeks and they put him on Invega 234 mg and Clozapine 300mg. he was taking Clozapine OK & got better but he refused to take weekly blood draws. I ended up crashing with clozapine medicine for him in his smoothee or Coffee then he left my state and ended traveling to a different state and got so sick. I had to contact a local investigator to look for him and it was a miracle to find him hanging around a coffee shop in Houston Texas. he lost his debit card and homeless people stole his phone and his wallet. it was a pain to get him back home… Long story
in another hospital in California, he was conserved for 2 years between 2018 through 2020 and they put him on Clozapine 450mg and medium shot invega. he got better in 2019 and he was sent to a Facility but in the Facility they dropped the Invega Shot and kept on Clozapine 450 mg but he became aggressive after 2 months and they send him back to the Hospital in CA and the doctor decided to try other combination of meds because he was there for more than year and they did not want to keep much longer than this. He got better on 6 different medicines: 2 antipsychotic, 2 Anxiety and mood stabilizer and other medicine for side effects
. After being discharged from California Hospital and coming to stay with me in 2020, he started cutting all medicine and ended up in Hospital here in my town for one month… and more hospitalizations follows…
These hospitalizations are not very effective since they keep him at most 2 to 4 weeks and he got very upset with me when I hospitalized him.
In my state, to get into a State Hospital for a long time, someone has to commit a felony and put in jail and wait for like 6 months before he is admitted to a State hospital so he can be treated for a long period of time. What a Mental Health System!!
I will not go this route and cause my son to be in Jail and get so sick before he can get the help he needs.
For now, I have him safe at home and stable to a certain level. Even Though he hears voices, he is not aggressive with me. As long as he gets his cigarettes and coffee, he is happy.
My option now is to wait for Angry Moms to get the approval of lowering the Clozapine Requirements to one months instead of one week for blood draw then his doctor can switch him from Zyprexa to Clozapine.
i will keep praying about my son Condition.
Thanks for reading my long report…
Caregiver1,
how much lithium is your son is on. how old s your Son.
I am worried about the Lithium side effects!
Thanks Catherine for your comments and uplifting words. it is a long joureny with my son…
it has been 10 years so far and I am hoping that things will start getting better as it gets older.
I heard this from some Physciatric that things will get better with Age.
I do wrorry about him if something happens to me. praying about this always…
God is here and he is loving and caring and generous. 
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I missed he previous meeting…
Can you provide me with instructions on how to join the meeting. when is the next meeting?
will check the Facebook group…
He was on lithium for about 14 years from 20-34. I think it was 1200 mg for much of the first 10 years and then was being tapered off during the last 4 years.
It was discovered he had chronic kidney disease and he now sees a nephrologist every 6 months for monitoring. The latest eFGR was 72, which is Stage 2 chronic kidney disease. I’m going with him to see the nephrologist this month and will report on his latest eFGR. This looks like a good article on the subject: Key questions on the long term renal effects of lithium: a review of pertinent data
my son was given depakote instead of Lithium at some hospital but somehow it get changed to Lithium. so far my son eFGR has been OK
I see these measures
Category GFR Interpretation:
G1 90 or greater Normal or high*
G2 60-89 Mild decrease*
G3a 45-59 Mild to moderate decrease
G3b 30-44 Moderate to severe decrease
so your son number is mild decrease.
My son ANC was little High little about 6.2 but his doctor said it is normal and not to be concerned…
How often do you do blood test for your son?
He’s no longer on lithium, but on 10 mg of olanzapine and 150 mg of quetiapine. Those can cause metabolic issues like high triglycerides. I think he gets tested every 6 months. I’m going with him to see a nephrologist this month and they do blood testing. I’ll ask about the eFGR and anything else that might affect his kidneys.
is your son doing OK on 10 mg of olanzapine( Zyprexa) and 150 mg of quetiapine ( Seroquel)?
Please let me know the results after you see the nephrologist.
Yes, he’s doing well, but I worry about long-term effects such as metabolic problems (he’s overweight) and movement disorders, although he’s not showing any right now.
His psychiatrist has been tapering the meds, but he may have decided the current dose is the end point. I’ll have to wait another month or two to see if there is going to be any further reduction.
He was moved from lithium (bipolar diagnosis) to APs about 4 years ago when he became actively psychotic.
Have you checked out Cobenfy? It’s a new drug for schizophrenia.
Cobenfy