The Carlat Psychiatry Podcast How to Start a Psych Medication V
Sep 15, 2025
The discussion dives into the careful titration of clozapine and lamotrigine, emphasizing the importance of slow dosage increases for patient safety. A spotlight on lamotrigine reveals essential guidelines for rash management, particularly in bipolar depression cases. Recent research on panic disorders introduces findings about the effectiveness of sertraline and propranolol for women suffering from panic attacks, highlighting promising treatment options. This insightful conversation emphasizes both the challenges and advancements in psychiatric medication management.
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Why Clozapine Needs Slow Titration
- Slow titration of clozapine reduces more than hypotension; it prevents inflammatory allergic reactions.
- Monitoring inflammation explains why clinicians start at 12.5–25 mg and raise by 25–50 mg increments.
Monitor Inflammatory Markers During Clozapine Start
- Check C-reactive protein and troponin weekly during clozapine initiation for the first 4–8 weeks.
- Slow or stop titration if inflammatory markers rise or if myocarditis symptoms appear.
Titration Triggers An Inflammatory Cascade
- Rapid titration can trigger an inflammatory cascade that presents like an allergy.
- That cascade causes myocarditis with clozapine and severe skin/hepatic reactions with lamotrigine.
