Hello and thank you for the question Lester.
Answers given are for informational purposes only and are not meant to replace an exam by an in-person.
I am Dr. Sohaib, a practicing Internal Medicine Specialist and i will do my best to help you today.
The maximum daily dose of clozapine is 900 mg in 24 hours, but it has been seen that most of the patients get desired results at doses 400 to 600 mg per day.
Whether or not the drug dose should be increased depend upon the patient's tolerability to that particular drug, and for clozapine you must know that there are some serious side effects that need to be watched closely before making any dose increments (it reduces white cell counts as well as increases the chances of seizures).
The dose can be increased from 500 to 600 only if the patient has been taking the 500mg daily dose for over 2 weeks (which allows her system to adapt to these drugs and prevent chances of any side effects that might occur when the dose is increased).
So these are not only the assays, but also the clinical indicators as well as lab tests (like blood cbc) that should be considered before increasing drug dose.
Honestly in this case, her physician is the best judge to decide whether the dose should be increased or not, and even if this is planned, it should be done very carefully as well as under close supervision of the doctor.
You should not do this yourself. Because we all want to make sure that she remains safe and free from any serious side effects.
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I am very happy with your answer. I will give a bonus. But first please confirm that an increase from 500mg in 24 hours to 600mg in 24 hours could reduce WBC.
My daughter has been on 500mg in 24 hours since 2011, could an increase still reduce WBC?
Thank you very much for the follow up question.
Extremely unlikely that raising the dose will affect the white cell count with in 24 hours. This may take few days to affect the white cell count.
And this is not necessary that increasing the drug dose will reduce the white cell count in all the cases.
This is experienced by few people, but due to serious nature of this side effect, it need to be monitored in all cases especially when the dose in increased.