Orthostasis: A Significant Side-Effect of Clozapine

Clozapine, an antipsychotic medication, has a high affinity for alpha-1 adrenergic receptors, which can cause orthostasis. This side effect, which is not always dose-dependent, affects around 20% of patients. Orthostasis can limit clozapine titration and prevent patients from reaching therapeutic levels. To manage orthostasis, practitioners should use the slowest titration that seems reasonable and encourage fluid intake. They should also minimize other medications that contribute to orthostasis risk, like other alpha-1 antagonists and benzodiazepines. Efficient management strategies and regular monitoring of blood pressure can aid in addressing orthostasis.