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Clozapine

Prescription ANDA TE AB Official labelling
Informational index, not medical advice. Content is reproduced from public FDA and NLM data. Always confirm against the manufacturer's current prescribing information. Report adverse events to FDA MedWatch.

Overview

Brand name
Clozapine
Generic name
Clozapine
Dosage form
Tablet, Orally Disintegrating
Route
Oral
Marketing category
ANDA · ANDA
Labeler
Teva Pharmaceuticals USA, Inc.
Product type
Human Prescription Drug
DEA schedule
Not scheduled
Active ingredients
5
NDC product codes
16
Packages
24
Data completeness
83% of corroborating sources present

Active ingredients

Source: NDC Directory
Active ingredients and strengths as listed in the NDC Directory.
Ingredient Strength RxCUI Monograph
Clozapine 100 mg/1 197535 View
Clozapine 12.5 mg/1 197535 View
Clozapine 150 mg/1 197535 View
Clozapine 200 mg/1 197535 View
Clozapine 25 mg/1 197535 View

Forms, strengths and routes

Source: NDC Directory
Dosage form
Tablet, Orally Disintegrating
Route of administration
Oral
Presentations
40

Pharmacologic classes are listed in the class section below.

Pharmacologic class

Source: NDC Directory
Established pharmacologic classes (EPC), mechanisms of action (MoA), chemical structures (CS) and physiologic effects (PE).
Class Type Browse
Atypical Antipsychotic [EPC] EPC All 62 members

Regulatory status

Source: Drugs@FDANDC Directory
Application number
201824
Application type
ANDA · Abbreviated New Drug Application
Approval date
September 15, 2015
Sponsor
MYLAN
Products on application
5
Submissions recorded
14
Products approved under application 201824.
Product Trade name Form Strength Ingredient Status TE Flags
201824-001 CLOZAPINE TABLET, ORALLY DISINTEGRATING CLOZAPINE None (Tentative Approval) —
201824-002 CLOZAPINE TABLET, ORALLY DISINTEGRATING CLOZAPINE Prescription AB
201824-003 CLOZAPINE TABLET, ORALLY DISINTEGRATING CLOZAPINE Prescription AB
201824-004 CLOZAPINE TABLET, ORALLY DISINTEGRATING CLOZAPINE Prescription AB
201824-005 CLOZAPINE TABLET, ORALLY DISINTEGRATING CLOZAPINE Prescription AB

Therapeutic equivalence

Source: Orange Book
TE code
AB
Reference Listed Drug
No
Reference Standard
No

What this rating means: Therapeutically equivalent — bioequivalence demonstrated by in vivo or in vitro testing

Codes beginning with “A” indicate products the FDA considers therapeutically equivalent. Codes beginning with “B” indicate bioequivalence has not been established. See methodology.

Approval history

Source: Drugs@FDA
Most recent submissions on application 201824.
Type No. Action Status Date Review
Supplement 28 Labeling Approved June 13, 2025 Standard
Supplement 27 REMS Approved June 13, 2025 —
Supplement 26 Labeling Approved January 22, 2025 Standard
Supplement 22 Labeling Approved April 26, 2023 Standard
Supplement 16 REMS Approved November 10, 2021 —
Supplement 15 REMS Approved July 29, 2021 —
Supplement 13 REMS Approved February 18, 2021 —
Supplement 11 Labeling Approved July 26, 2020 Standard
Supplement 9 REMS Approved January 16, 2019 —
Supplement 7 Labeling Approved November 17, 2017 Standard
Supplement 5 Labeling Approved January 22, 2016 Standard
Supplement 4 Labeling Approved January 22, 2016 Standard
Original application 2 Not Applicable Tentative approval September 15, 2015 —
Original application 1 Not Applicable Approved September 15, 2015 —

Review documents

  • REMS · Original application · September 18, 2015
  • 0 · Original application · September 17, 2015

Prescribing information

Source: openFDA Drug Labeling

Reproduced verbatim from the Structured Product Labeling submitted to the FDA (effective 20250815). This is the manufacturer's labelling text, not a summary and not advice.

HUMAN PRESCRIPTION DRUG · 20250815 HUMAN PRESCRIPTION DRUG · 20250718 HUMAN PRESCRIPTION DRUG · 20250624 HUMAN PRESCRIPTION DRUG · 20250605

Boxed Warning

openFDA Drug Labeling

WARNING: SEVERE NEUTROPENIA; ORTHOSTATIC HYPOTENSION, BRADYCARDIA, AND SYNCOPE; SEIZURE; MYOCARDITIS, PERICARDITIS, AND CARDIOMYOPATHY; INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Severe Neutropenia Clozapine treatment has caused severe neutropenia, defined as an absolute neutrophil count (ANC) less than 500/μL. Severe neutropenia can lead to serious infection and death. Prior to initiating treatment with clozapine orally disintegrating tablets, a baseline ANC must be at least 1500/μL for the general population; and must be at least 1000/μL for patients with documented Benign Ethnic Neutropenia (BEN). During treatment, patients must have regular ANC monitoring. Advise patients to immediately report symptoms consistent with severe neutropenia or infection (e.g., fever, weakness, lethargy, or sore throat) [see Dosage and Administration (2.1) and Warnings and Precautions (5.1) ] . Because of the risk of severe neutropenia, clozapine orally disintegrating tablets are available only through a restricted program under a Risk Evaluation Mitigation Strategy (REMS) called the Clozapine REMS Program [see Warnings and Precautions (5.2) ] . Orthostatic Hypotension, Bradycardia, Syncope Orthostatic hypotension, bradycardia, syncope, and cardiac arrest have occurred with clozapine treatment. The risk is highest during the initial titration period, particularly with rapid dose escalation. These reactions can occur with the first dose, with doses as low as 12.5 mg per day, or when restarting patients who have had even a brief interruption in treatment with clozapine orally disintegrating tablets. Initiate treatment at 12.5 mg once or twice daily; titrate slowly; and use divided dosages to minimize risk. Use clozapine orally disintegrating tablets cautiously in patients with cardiovascular or cerebrovascular disease or conditions predisposing to hypotension (e.g., dehydration, use of antihypertensive medications) [see Dosage and Administration (2.3 , 2.6) , Warnings and Precautions (5.3) ] . Seizures Seizures have occurred with clozapine treatment. The risk is dose-related. Initiate treatment at 12.5 mg, titrate gradually, and use divided dosing. Use caution when administering clozapine orally disintegrating tablets to patients with a history of seizures or other predisposing risk factors for seizure (CNS pathology, medications that lower the seizure threshold, alcohol abuse). Caution patients about engaging in any activity where sudden loss of consciousness could cause serious risk to themselves or others [see Dosage and Administration (2.3) and Warnings and Precautions (5.5) ] . Myocarditis, Pericarditis, Cardiomyopathy and Mitral Valve Incompetence Fatal myocarditis and cardiomyopathy have occurred with clozapine treatment. Discontinue clozapine orally disintegrating tablets and obtain a cardiac evaluation upon suspicion of these reactions. Generally, patients with clozapine orally disintegrating tablets-related myocarditis or cardiomyopathy should not be rechallenged with clozapine orally disintegrating tablets. Consider the possibility of myocarditis, pericarditis, or cardiomyopathy if chest pain, tachycardia, palpitations, dyspnea, fever, flu-like symptoms, hypotension, or ECG changes occur [see Warnings and Precautions (5.6) ] . Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Clozapine orally disintegrating tablets are not approved for use in patients with dementia-related psychosis [see Warnings and Precautions (5.7) ] . WARNING: SEVERE NEUTROPENIA; ORTHOSTATIC HYPOTENSION, BRADYCARDIA, AND SYNCOPE; SEIZURE; MYOCARDITIS, PERICARDITIS, AND CARDIOMYOPATHY; INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS See full prescribing information for complete boxed warning. Severe Neutropenia: Clozapine can cause severe neutropenia, which can lead to serious …

Recent Major Changes

openFDA Drug Labeling

Boxed Warning , Severe Neutropenia 3/2025 Boxed Warning , Myocarditis, Pericarditis, Cardiomyopathy and Mitral Valve Incompetence 9/2024 Absolute Neutrophil Count Testing Prior to Clozapine ODT Initiation ( 2.1 ) 3/2025 Recommended Dosage and Administration ( 2.2 ) 3/2025 Dosage Modifications Based on ANC Results ( 2.3 ) 3/2025 Dosage Modifications Based on ANC Results for Patients with Benign Ethnic Neutropenia ( 2.4 ) 3/2025 Discontinuation of Clozapine ODT Treatment ( 2.5 ) 3/2025 Restarting Clozapine ODT Treatment After Interrupting Clozapine ODT ( 2.6 ) 3/2025 Dosage Modifications for Drug Interactions ( 2.7 ) 3/2025 Dosage Recommendations in Patients with Renal or Hepatic Impairment, or CYP2D6 Poor Metabolizers ( 2.8 ) 3/2025 Severe Neutropenia ( 5.1 ) 3/2025 Myocarditis, Pericarditis, Cardiomyopathy and Mitral Valve Incompetence ( 5.5 ) 9/2024

Indications and Usage

openFDA Drug Labeling

1 INDICATIONS AND USAGE Clozapine orally disintegrating tablets (Clozapine ODT) is an atypical antipsychotic indicated for: • Treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. Because of the risks of severe neutropenia and of seizure associated with its use, Clozapine ODT should be used only in patients who have failed to respond adequately to standard antipsychotic treatment ( 1.1 ) • Reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for re-experiencing suicidal behavior ( 1.2 ) 1.1 Treatment-resistant Schizophrenia Clozapine Orally Disintegrating Tablets (Clozapine ODT) are indicated for the treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. Because of the risks of severe neutropenia and of seizure associated with their use, Clozapine ODT should be used only in patients who have failed to respond adequately to standard antipsychotic treatment [see Warnings and Precautions (5.1 , 5.4) ]. The effectiveness of Clozapine ODT in treatment-resistant schizophrenia was demonstrated in a 6-week, randomized, double-blind, active-controlled study comparing Clozapine ODT and chlorpromazine in patients who had failed other antipsychotics [see Clinical Studies (14.1) ]. 1.2 Reduction in the Risk of Recurrent Suicidal Behavior in Schizophrenia or Schizoaffective Disorder Clozapine ODT is indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for re-experiencing suicidal behavior, based on history and recent clinical state. Suicidal behavior refers to actions by a patient that put him/herself at risk for death. The effectiveness of Clozapine ODT in reducing the risk of recurrent suicidal behavior was demonstrated over a two-year treatment period in the InterSePTTM trial [see Clinical Studies (14.2) ] .

Dosage and Administration

openFDA Drug Labeling

2 DOSAGE AND ADMINISTRATION Recommended starting oral dosage is 12.5 mg once daily or twice daily. ( 2.2 ) If well-tolerated, increase the total daily dosage in increments of 25 mg to 50 mg per day at target dosage of 150 mg to 225 mg twice per day by the end of two weeks ( 2.2 ) Subsequently may increase the dosage in increments up to 100 mg, once or twice weekly. ( 2.2 ) Maximum daily dosage is 450 mg twice daily. ( 2.2 ) Administer with or without food. Clozapine ODT may be allowed to disintegrate or chewed, and may be taken with or without water. See additional administration instructions in full prescribing information ( 2.2 ). See dosage modification based on ANC results ( 2.3 , 2.4 ) See recommendations for discontinuing Clozapine ODT treatment ( 2.5 ), restarting Clozapine ODT after interrupting dosing ( 2.6 ), dosage modifications for drug interactions ( 2.7 ), dosage recommendations in patients with renal or hepatic impairment and CYP2D6 poor metabolizers ( 2.8 ) in the full prescribing information. Tablets rapidly disintegrate after placement in the mouth and may be chewed if desired. No water is needed ( 2.3 ). 2.1 Absolute Neutrophil Count Testing Prior to Clozapine ODT Initiation Prior to initiating Clozapine ODT treatment, obtain a baseline absolute neutrophil count (ANC). Clozapine ODT initiation is not recommended in patients with an ANC less than 1500/μL [see Warnings and Precautions (5.1) ]. For patients with documented Benign Ethnic Neutropenia (BEN) (also known as Duffy-null associated neutrophil count)), obtain at least two baseline ANC levels. Clozapine ODT initiation is not recommended in patients with BEN with an ANC less than 1000/μL [see Warnings and Precautions (5.1) ]. For dosage modifications based on ANC results, see Dosage and Administration (2.4 , 2.5) . 2.2 Recommended Dosage and Administration Recommended Dosage To reduce the risk of orthostatic hypotension, bradycardia, and syncope, the recommended starting dosage is much lower than the target dosage [see Warnings and Precautions (5.3) ]. The recommended starting oral dosage of Clozapine ODT is 12.5 mg once or twice daily. If well-tolerated, increase the total daily dose in increments of 25 mg to 50 mg per day to achieve a target dosage of 150 mg to 225 mg twice per day by the end of two weeks. Subsequently, may increase the dosage in increments of up to 100 mg once weekly or twice weekly. The maximum recommended Clozapine ODT oral dosage is 450 mg twice daily. Administration Instructions Clozapine ODT can be taken with or without food, may be allowed to disintegrate or chewed, and may be taken with or without water [see Clinical Pharmacology (12.3) ]. Just prior to use, peel the foil from the blister and gently remove the orally disintegrating tablet (ODT). Do not push the ODT through the foil, because this could damage the ODT. After removing Clozapine ODT from the blister pack or bottle, immediately place in the mouth. 2.3 Dosage Modifications Based on ANC Results Table 1 provides recommended Clozapine ODT dosage modifications based on ANC results [see Warnings and Precautions (5.1) ]. For dosage modifications based on ANC results for patients with Benign Ethnic Neutropenia (BEN) (also known as Duffy-null associated neutrophil count), see Table 2 [see Dosage and Administration (2.5) ]. Table 1: Clozapine ODT Dosage Modifications Based on ANC Results and Frequency of ANC Testing 1 Confirm all initial reports of ANC less than 1500/μL with a repeat ANC measurement within 24 hours Recommended Dosage Modification Recommended Frequency of ANC Testing During Clozapine ODT Treatment ANC Within Normal Range (≥ 1500/μL) No dosage modification; continue treatment Day 1 to Month 6: Weekly Month 7 to Month 12: Every 2 weeks Month 13 and thereafter: Every month If Clozapine ODT treatment is reinitiated after a dosage interruption (e.g., patient had neutropenia which required dosage interruption and now has a normal ANC level) for: 1000/μL, three times …

Dosage Forms and Strengths

openFDA Drug Labeling

3 DOSAGE FORMS AND STRENGTHS Clozapine Orally Disintegrating Tablets are available as: 12.5 mg: yellow to pale yellow color, round shaped tablet, flat faced bevelled edge debossed with “CLO” on one side and “12.5” on the other side. 25 mg: yellow to pale yellow color, round shaped tablet, flat faced bevelled edge debossed with “CLO” on one side and “25” on the other side. 100 mg: yellow to pale yellow color, round shaped tablet, flat faced bevelled edge debossed with “CLO” on one side and “100” on the other side. 150 mg: yellow to pale yellow color, round shaped tablet, flat faced bevelled edge debossed with “CLO” on one side and “150” on the other side. 200 mg: yellow to pale yellow color, round shaped tablet, flat faced bevelled edge debossed with “CLO” on one side and “200” on the other side. Orally disintegrating tablets: 12.5 mg, 25 mg, 100 mg, 150 mg and 200 mg (3)

Contraindications

openFDA Drug Labeling

4 CONTRAINDICATIONS Clozapine orally disintegrating tablets are contraindicated in patients with a history of serious hypersensitivity to clozapine (e.g., photosensitivity, vasculitis, erythema multiforme, or Stevens-Johnson Syndrome) or any other component of clozapine orally disintegrating tablets [see Adverse Reactions (6.2) ] . Known serious hypersensitivity to clozapine or any other component of clozapine orally disintegrating tablets ( 4 ).

Warnings and Cautions

openFDA Drug Labeling

5 WARNINGS AND PRECAUTIONS Severe neutropenia: See Boxed Warning ( 5.1 ) Gastrointestinal Hypomotility with Severe Complications: Severe gastrointestinal adverse reactions have occurred with the use of clozapine. If constipation is identified, close monitoring and prompt treatment is advised. ( 5.7 ) Eosinophilia : Assess for organ involvement (e.g., myocarditis, pancreatitis, hepatitis, colitis, nephritis). Discontinue if these occur. ( 5.8 ) QT Interval Prolongation : Can be fatal. Consider additional risk factors for prolonged QT interval (disorders and drugs). ( 5.9 ) Metabolic Changes : Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk. These metabolic changes include ( 5.10 ): Hyperglycemia and Diabetes Mellitus: Monitor for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Monitor glucose regularly in patients with diabetes or at risk for diabetes. Dyslipidemia: Undesirable alterations in lipids have occurred in patients treated with atypical antipsychotics. Weight Gain: Significant weight gain has occurred. Monitor weight gain. Neuroleptic Malignant Syndrome (NMS) : Immediately discontinue and monitor closely. Assess for co-morbid conditions. ( 5.11 ) Hepatotoxicity: Can be fatal. Monitor for hepatotoxicity. Discontinue treatment if hepatitis or transaminase elevations combined with other symptoms occur ( 5.12 ). Fever : Evaluate for infection and for neutropenia, NMS. ( 5.14 ) Pulmonary Embolism (PE) : Consider PE if respiratory distress, chest pain, or deep-vein thrombosis occurs. ( 5.15 ) Anticholinergic Toxicity : When possible, avoid use with other anticholinergic drugs and use with caution in patients with a current diagnosis or prior history of constipation, urinary retention, clinically significant prostatic hypertrophy, or other conditions in which anticholinergic effects can lead to significant adverse reactions. ( 5.15 , 7.1 ) Interference with Cognitive and Motor Performance : Advise caution when operating machinery, including automobiles. ( 5.16 ) 5.1 Severe Neutropenia Clozapine has caused severe neutropenia (absolute neutrophil count (ANC) less than 500/μL) [see Adverse Reactions ( 6.1 , 6.2 )] and is associated with an increased risk of serious and potentially fatal infections. Severe neutropenia occurred in a small percentage of clozapine-treated patients. The risk of severe neutropenia appears greatest during the first 18 weeks of Clozapine ODT treatment. The mechanism by which Clozapine ODT causes neutropenia is unknown. Neutropenia is not dose-dependent. Consider a hematology consultation before initiating Clozapine ODT treatment or during treatment. ANC Monitoring and Dosage Modifications Prior to initiating Clozapine ODT treatment, obtain a baseline ANC. Clozapine ODT initiation is not recommended in patients with a baseline ANC less than 1500/μL. Throughout VERSACLOZ treatment, regularly monitor ANC. Table 1 provides recommendations for dosage modifications (dosage interruption and treatment discontinuation), based on ANC levels, during Clozapine ODT treatment and frequency of ANC monitoring [see Dosage and Administration ( 2.4 )] . ANC Monitoring and Dosage Modification in Patients with Benign Ethnic Neutropenia Patients with Benign Ethnic Neutropenia (BEN) (also known as Duffy-null associated neutrophil count) generally have lower baseline neutrophil counts but they are not at higher risk for developing infections, and they are not at increased risk for developing Clozapine ODT-induced neutropenia. For patients with documented BEN, obtain at least two baseline ANC levels prior to Clozapine ODT initiation. Clozapine ODT initiation is not recommended in patients with BEN with an ANC less than 1000/μL. There are different ANC dosage modification recommendations in Clozapine ODT-treated patients with BEN due to their lower baseline ANC levels. Table 2 provides recommendations on dosage mod …

Adverse Reactions

openFDA Drug Labeling

6 ADVERSE REACTIONS The following adverse reactions are discussed in more detail in other sections of the labeling: • Severe Neutropenia [see Warnings and Precautions (5.1) ] • Orthostatic Hypotension, Bradycardia, and Syncope [see Warnings and Precautions (5.2) ] • Falls [see Warnings and Precautions (5.3) ] • Seizures [see Warnings and Precautions (5.4) ] • Myocarditis, Pericarditis, Cardiomyopathy, and Mitral Valve Incompetence [see Warnings and Precautions (5.5) ] • Increased Mortality in Elderly Patients with Dementia-Related Psychosis [see Warnings and Precautions (5.6) ] • Gastrointestinal Hypomotility with Severe Complications [see Warnings and Precautions (5.7) ] • Eosinophilia [see Warnings and Precautions (5.8) ] • QT Interval Prolongation [see Warnings and Precautions (5.9) ] • Metabolic Changes (Hyperglycemia and Diabetes Mellitus, Dyslipidemia, and Weight Gain) [see Warnings and Precautions (5.10) ] • Neuroleptic Malignant Syndrome [see Warnings and Precautions (5.11) ] • Hepatotoxicity [see Warnings and Precautions (5.12) ] • Fever [see Warnings and Precautions (5.13) ] • Pulmonary Embolism [see Warnings and Precautions (5.14) ] • Anticholinergic Toxicity [see Warnings and Precautions (5.15) ] • Interference with Cognitive and Motor Performance [see Warnings and Precautions (5.16) ] • Tardive Dyskinesia [see Warnings and Precautions (5.17) ] • Patients with Phenylketonuria [see Warnings and Precautions (5.18) ] • Cerebrovascular Adverse Reactions [see Warnings and Precautions (5.19) ] • Recurrence of Psychosis and Cholinergic Rebound after Abrupt Discontinuation [see Warnings and Precautions (5.20) ] Most common adverse reactions (≥ 5%) were: CNS reactions (sedation, dizziness/vertigo, headache, and tremor); cardiovascular reactions (tachycardia, hypotension, and syncope); autonomic nervous system reactions (hypersalivation, sweating, dry mouth, and visual disturbances); gastrointestinal reactions (constipation and nausea); and fever. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Mylan at 1-877-446-3679 (1-877-4-INFO-RX) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The most commonly reported adverse reactions (≥ 5%) across clozapine clinical trials were: CNS reactions, including sedation, dizziness/vertigo, headache, and tremor; cardiovascular reactions, including tachycardia, hypotension, and syncope; autonomic nervous system reactions, including hypersalivation, sweating, dry mouth, and visual disturbances; gastrointestinal reactions, including constipation and nausea; and fever. Table 9 summarizes the most commonly reported adverse reactions (≥ 5%) in clozapine-treated patients (compared to chlorpromazine-treated patients) in the pivotal, 6-week, controlled trial in treatment-resistant schizophrenia. Table 9: Common Adverse Reactions (≥ 5%) in the 6-Week, Randomized, Chlorpromazine-Controlled Trial in Treatment-Resistant Schizophrenia Adverse Reaction Clozapine (N = 126) (%) Chlorpromazine (N = 142) (%) Sedation 21 13 Tachycardia 17 11 Constipation 16 12 Dizziness 14 16 Hypotension 13 38 Fever (hyperthermia) 13 4 Hypersalivation 13 1 Hypertension 12 5 Headache 10 10 Nausea/vomiting 10 12 Dry mouth 5 20 Table 10 summarizes the adverse reactions reported in clozapine-treated patients at a frequency of 2% or greater across all clozapine studies (excluding the 2 year InterSePTTM Study). These rates are not adjusted for duration of exposure. Table 10: Adverse Reactions (≥ 2%) Reported in Clozapine-treated Patients (N = 842) Across all Clozapine Studies (excluding the 2 year InterSePTTM Study) Body System Adverse Reaction Clozapine N = 842 Percentage of Patients Central Nervous System Drowsiness/Sedatio …

Drug Interactions

openFDA Drug Labeling

7 DRUG INTERACTIONS Concomitant use of Strong CYP1A2 Inhibitors: Reduce clozapine orally disintegrating tablets dose to one-third when coadministered with strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, enoxacin) ( 2.7 , 7.1 ). Concomitant use of Strong CYP3A4 Inducers is not recommended ( 2.7 , 7.1 ). Discontinuation of CYP1A2 or CYP3A4 Inducers: Consider reducing clozapine orally disintegrating tablets dose when CYP1A2 (e.g., tobacco smoke) or CYP3A4 inducers (e.g., carbamazepine) are discontinued ( 2.7 , 7.1 ). Anticholinergic drugs: Concomitant use may increase the risk for anticholinergic toxicity ( 5.8 , 5.16 , 7.1 ). 7.1 Potential for Other Drugs to Affect Clozapine Orally Disintegrating Tablets Clozapine is a substrate for many cytochrome P450 isozymes, in particular CYP1A2, CYP3A4, and CYP2D6. Use caution when administering clozapine orally disintegrating tablets concomitantly with drugs that are inducers or inhibitors of these enzymes. CYP1A2 Inhibitors Concomitant use of clozapine orally disintegrating tablets and CYP1A2 inhibitors can increase plasma levels of clozapine, potentially resulting in adverse reactions. Reduce the clozapine orally disintegrating tablets dose to one-third of the original dose when clozapine orally disintegrating tablets are coadministered with strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, or enoxacin). The clozapine orally disintegrating tablets dose should be increased to the original dose when coadministration of strong CYP1A2 inhibitors is discontinued [see Dosage and Administration (2.7) and Clinical Pharmacology (12.3) ] . Moderate or weak CYP1A2 inhibitors include oral contraceptives and caffeine. Monitor patients closely when clozapine orally disintegrating tablets are coadministered with these inhibitors. Consider reducing the clozapine orally disintegrating tablets dosage if necessary [see Dosage and Administration (2.7) ] . CYP2D6 and CYP3A4 Inhibitors Concomitant treatment with clozapine orally disintegrating tablets and CYP2D6 or CYP3A4 inhibitors (e.g., cimetidine, escitalopram, erythromycin, paroxetine, bupropion, fluoxetine, quinidine, duloxetine, terbinafine, or sertraline) can increase clozapine levels and lead to adverse reactions [see Clinical Pharmacology (12.3) ] . Use caution and monitor patients closely when using such inhibitors. Consider reducing the clozapine orally disintegrating tablets dose [see Dosage and Administration (2.7) ] . CYP1A2 and CYP3A4 Inducers Concomitant treatment with drugs that induce CYP1A2 or CYP3A4 can decrease the plasma concentration of clozapine, resulting in decreased effectiveness of clozapine orally disintegrating tablets. Tobacco smoke is a moderate inducer of CYP1A2. Strong CYP3A4 inducers include carbamazepine, phenytoin, St. John’s wort, and rifampin. It may be necessary to increase the clozapine orally disintegrating tablets dose if used concomitantly with inducers of these enzymes. However, concomitant use of clozapine orally disintegrating tablets and strong CYP3A4 inducers is not recommended [see Dosage and Administration (2.7) ] . Consider reducing the clozapine orally disintegrating tablets dosage when discontinuing coadministered enzyme inducers, because discontinuation of inducers can result in increased clozapine plasma levels and an increased risk of adverse reactions [see Dosage and Administration (2.7) ] . Anticholinergic Drugs Concomitant treatment with clozapine and other drugs with anticholinergic activity (e.g., benztropine, cyclobenzaprine, diphenhydramine) can increase the risk for anticholinergic toxicity and severe gastrointestinal adverse reactions related to hypomotility. Avoid concomitant use of clozapine orally disintegrating tablets with anticholinergic drugs when possible [see Warnings and Precautions (5.8 , 5.16) ] . Drugs that Cause QT Interval Prolongation Use caution when administering concomitant medications that prolong the QT interval or inhibit the metabolism of clozapine …

Use in Specific Populations

openFDA Drug Labeling

8 USE IN SPECIFIC POPULATIONS Lactation : Infants exposed to Clozapine ODT through breast milk should be monitored for excess sedation and neutropenia. ( 8.2 ) 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, including Clozapine ODT, during pregnancy. Healthcare providers are encouraged to advise patients to register by calling the National Pregnancy Registry for Atypical Antipsychotics at1-866-961-2388 or visiting http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/. Risk Summary Neonates exposed to antipsychotic drugs, including Clozapine ODT, during the third trimester are at risk for extrapyramidal and/or withdrawal symptoms following delivery ( see Clinical Considerations ). Available data from published epidemiologic studies over decades of use with clozapine during pregnancy have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes ( see Data ). There are risks to the mother associated with untreated schizophrenia and with exposure to antipsychotics, including Clozapine ODT, during pregnancy ( see Clinical Considerations ). In animal reproduction studies, no adverse developmental effects were observed when clozapine was administered orally to pregnant rats or rabbits during the period of organogenesis, or to pregnant rats during pregnancy and lactation, at doses up to approximately 0.4 and 0.9 times the maximum recommended human dose (MRHD) of 900 mg/day, for rats and rabbits respectively, based on mg/m 2 body surface area ( see Data ). The background risk of major birth defects and miscarriage for the indicated populations is unknown. All pregnancies have a background risk of birth defects, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Clinical Considerations Disease-associated maternal and/or embryo/fetal risk There is a risk to the mother from untreated schizophrenia, including increased risk of relapse, hospitalization, and suicide. Schizophrenia is associated with increased adverse perinatal outcomes, including preterm birth. It is not known if this is a direct result of the illness or other comorbid factors. Fetal/Neonatal adverse reactions Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder have been reported in neonates who have been exposed to antipsychotic drugs, including Clozapine ODT, during the third trimester of pregnancy. These symptoms have varied in severity. Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately. Some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization. Data Animal Data In embryofetal developmental studies, clozapine had no effects on maternal parameters, litter sizes, or fetal parameters when administered orally to pregnant rats and rabbits during the period of organogenesis at doses up to 0.4 and 0.9 times, respectively, the MRHD of 900 mg/day on a mg/m 2 body surface area basis. In peri/postnatal developmental studies, pregnant female rats were administered clozapine over the last third of pregnancy and until day 21 postpartum. Observations were made on fetuses at birth and during the postnatal period; the offspring were allowed to reach sexual maturity and mated. Clozapine caused a decrease in maternal body weight but had no effects on litter size or body weights of either F1 or F2 generations at doses up to 0.4 times the MRHD of 900 mg/day on a mg/m 2 body surface area basis. 8.2 Lactation Risk Summary Clozapine is present in human milk. There is one case report of sedation and a report of agranulocytosis in an infant exposed to …

Mechanism of Action

openFDA Drug Labeling

12.1 Mechanism of Action The mechanism of action of clozapine is unknown. However, it has been proposed that the therapeutic efficacy of clozapine in schizophrenia is mediated through antagonism of the dopamine type 2 (D 2 ) and the serotonin type 2A (5-HT 2A ) receptors. Clozapine orally disintegrating tablets also act as an antagonist at adrenergic, cholinergic, histaminergic and other dopaminergic and serotonergic receptors.

Description

openFDA Drug Labeling

11 DESCRIPTION Clozapine, an atypical antipsychotic drug, is a tricyclic dibenzodiazepine derivative, 8-chloro-11-(4-methyl-1-piperazinyl)-5 H -dibenzo [ b,e ] [1,4] diazepine. The structural formula is: Clozapine orally disintegrating tablets are available as peach, orally disintegrating tablets of 25 mg, 100 mg, 150 mg or 200 mg for oral administration without water. Clozapine orally disintegrating tablets may be chewed. Each orally disintegrating tablet contains clozapine equivalent to 25 mg, 100 mg, 150 mg or 200 mg. The active component of clozapine orally disintegrating tablets is clozapine. The remaining components are aspartame, crospovidone, FD&C Yellow No. 6 Aluminum Lake, magnesium stearate, mannitol, microcrystalline cellulose, peppermint flavor, silicon dioxide and sodium stearyl fumarate. THIS PRODUCT CONTAINS ASPARTAME AND IS NOT INTENDED FOR USE BY INFANTS. PHENYLKETONURICS: CONTAINS PHENYLALANINE [see Warnings and Precautions (5.19) ] . Phenylalanine is a component of aspartame. Each 25 mg, orally disintegrating tablet contains 3.38 mg aspartame, thus, 1.90 mg phenylalanine. Each 100 mg, orally disintegrating tablet contains 13.52 mg aspartame, thus, 7.59 mg phenylalanine. Each 150 mg, orally disintegrating tablet contains 20.28 mg aspartame, thus, 11.38 mg phenylalanine. Each 200 mg, orally disintegrating tablet contains 27.04 mg aspartame, thus, 15.18 mg phenylalanine. The allowable daily intake of aspartame is 50 mg per kilogram of body weight per day. Clozapine Structural Formula

10 OVERDOSAGE 10.1 Overdosage Experience The most commonly reported signs and symptoms associated with clozapine overdose are: sedation, delirium, coma, tachycardia, hypotension, respiratory depression or failure; and hypersalivation. There are reports of aspiration pneumonia, cardiac arrhythmias, and seizure. Fatal overdoses have been reported with clozapine, generally at doses above 2500 mg. There have also been reports of patients recovering from overdoses well in excess of 4 g. 10.2 Management of Overdosage There are no specific antidotes for clozapine orally disintegrating tablets. Establish and maintain an airway; ensure adequate oxygenation and ventilation. Monitor cardiac status and vital signs. Use general symptomatic and supportive measures. Consider the possibility of multiple-drug involvement. Contact a Certified Poison Control Center for the most up to date information on the management of overdosage (1-800-222-1222).

How Supplied / Storage and Handling

openFDA Drug Labeling

16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied 12.5 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I3 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5416-01). 25 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I7 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5417-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5417-84). 100 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I2 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5419-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5419-84). 150 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I1 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5376-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5376-84). 200 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with L1 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5377-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5377-84). 16.2 Storage and Handling Store Clozapine Orally Disintegrating Tablets (referred to as Clozapine ODT) at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Protect from moisture. Keep in a sealed blister until time of use. This unit-dose package is non child-resistant. Keep Clozapine ODT in the original package until used by the patient. Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required). The quantity of Clozapine ODT depends on the ANC testing results [see Warnings and Precautions ( 5.1 )]. If a patient is eligible for ANC testing: Every week, then a 1-week supply of Clozapine ODT can be dispensed. Every 2 weeks, then a 2-week supply of Clozapine ODT can be dispensed. Every 4 weeks, then a 4-week supply of Clozapine ODT can be dispensed.

16.1 How Supplied 12.5 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I3 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5416-01). 25 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I7 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5417-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5417-84). 100 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I2 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5419-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5419-84). 150 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with I1 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5376-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5376-84). 200 mg Yellow, round, flat-faced, beveled-edge, unscored tablet. Debossed with L1 on one side and plain on the other side. Available in bottles of 100 (NDC 0093-5377-01) and cartons of 48 tablets for Institutional Use Only (8x6 blister cards) (NDC 0093-5377-84).

Adverse event reports

Source: openFDA FAERS
124,828
FAERS reports mentioning this drug
as of 2026-09-25T03:42:24+00:00
A report count is not a risk measure. FAERS accepts voluntary and mandatory reports without establishing causation, and reporting is influenced by how widely a drug is used, how long it has been marketed, and media attention. FDA states that reports “do not prove that the drug caused the event”. Compare rates, not totals.

Attributed to this product's most-reported active ingredient: CLOZAPINE. Combination products with more than six active ingredients are not attributed, because a report count summed across a long ingredient list measures the list, not the medicine.

Recalls

Source: FDA Enforcement
Drug recall enforcement reports associated with this product.
Classification Reported Firm Reason Status
Class II October 10, 2018 Teva Pharmaceuticals USA Failed Disintegration Specifications: Out-of-specification disintegration test result obtained during routine stability testing. Terminated

Packaging and NDCs

Source: NDC Directory
Every National Drug Code package associated with this medication. The NDC is the identifier used for dispensing, billing and pharmacovigilance in the United States.
Package NDC Product NDC Labeler Description Marketing start
59651-260-01 59651-260 Aurobindo Pharma Limited 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (59651-260-01) December 12, 2024
59651-261-01 59651-261 Aurobindo Pharma Limited 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (59651-261-01) December 12, 2024
59651-261-48 59651-261 Aurobindo Pharma Limited 8 BLISTER PACK in 1 CARTON (59651-261-48) / 6 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK December 12, 2024
59651-262-01 59651-262 Aurobindo Pharma Limited 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (59651-262-01) December 12, 2024
59651-262-48 59651-262 Aurobindo Pharma Limited 8 BLISTER PACK in 1 CARTON (59651-262-48) / 6 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK December 12, 2024
59651-263-01 59651-263 Aurobindo Pharma Limited 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (59651-263-01) December 12, 2024
59651-263-48 59651-263 Aurobindo Pharma Limited 8 BLISTER PACK in 1 CARTON (59651-263-48) / 6 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK December 12, 2024
59651-264-01 59651-264 Aurobindo Pharma Limited 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (59651-264-01) December 12, 2024
59651-264-48 59651-264 Aurobindo Pharma Limited 8 BLISTER PACK in 1 CARTON (59651-264-48) / 6 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK December 12, 2024
51079-288-04 51079-288 Mylan Institutional Inc. 40 BLISTER PACK in 1 CARTON (51079-288-04) / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK (51079-288-01) September 26, 2016
0378-3813-01 0378-3813 Mylan Pharmaceuticals Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, PLASTIC (0378-3813-01) November 2, 2015
0378-3815-01 0378-3815 Mylan Pharmaceuticals Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, PLASTIC (0378-3815-01) November 2, 2015
0378-3816-01 0378-3816 Mylan Pharmaceuticals Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, PLASTIC (0378-3816-01) August 16, 2023
0378-3817-01 0378-3817 Mylan Pharmaceuticals Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, PLASTIC (0378-3817-01) August 16, 2023
48433-022-04 48433-022 Safecor Health, LLC 40 BLISTER PACK in 1 CARTON (48433-022-04) / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK (48433-022-01) March 5, 2026
0093-5376-01 0093-5376 Teva Pharmaceuticals USA, Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (0093-5376-01) July 30, 2020
0093-5376-84 0093-5376 Teva Pharmaceuticals USA, Inc. 48 BLISTER PACK in 1 CARTON (0093-5376-84) / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK (0093-5376-19) September 1, 2021
0093-5377-01 0093-5377 Teva Pharmaceuticals USA, Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (0093-5377-01) July 30, 2020
0093-5377-84 0093-5377 Teva Pharmaceuticals USA, Inc. 48 BLISTER PACK in 1 CARTON (0093-5377-84) / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK (0093-5377-19) July 30, 2020
0093-5416-01 0093-5416 Teva Pharmaceuticals USA, Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (0093-5416-01) April 17, 2018
0093-5417-01 0093-5417 Teva Pharmaceuticals USA, Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (0093-5417-01) July 25, 2017
0093-5417-84 0093-5417 Teva Pharmaceuticals USA, Inc. 48 BLISTER PACK in 1 CARTON (0093-5417-84) / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK (0093-5417-19) July 25, 2017
0093-5419-01 0093-5419 Teva Pharmaceuticals USA, Inc. 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (0093-5419-01) July 25, 2017
0093-5419-84 0093-5419 Teva Pharmaceuticals USA, Inc. 48 BLISTER PACK in 1 CARTON (0093-5419-84) / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK (0093-5419-19) July 25, 2017
59651-260 59651-260 Aurobindo Pharma Limited — December 12, 2024
59651-261 59651-261 Aurobindo Pharma Limited — December 12, 2024
59651-262 59651-262 Aurobindo Pharma Limited — December 12, 2024
59651-263 59651-263 Aurobindo Pharma Limited — December 12, 2024
59651-264 59651-264 Aurobindo Pharma Limited — December 12, 2024
51079-288 51079-288 Mylan Institutional Inc. — September 26, 2016
0378-3813 0378-3813 Mylan Pharmaceuticals Inc. — November 2, 2015
0378-3815 0378-3815 Mylan Pharmaceuticals Inc. — November 2, 2015
0378-3816 0378-3816 Mylan Pharmaceuticals Inc. — August 16, 2023
0378-3817 0378-3817 Mylan Pharmaceuticals Inc. — August 16, 2023
48433-022 48433-022 Safecor Health, LLC — March 5, 2026
0093-5376 0093-5376 Teva Pharmaceuticals USA, Inc. — July 30, 2020
0093-5377 0093-5377 Teva Pharmaceuticals USA, Inc. — July 30, 2020
0093-5416 0093-5416 Teva Pharmaceuticals USA, Inc. — April 17, 2018
0093-5417 0093-5417 Teva Pharmaceuticals USA, Inc. — July 25, 2017
0093-5419 0093-5419 Teva Pharmaceuticals USA, Inc. — July 25, 2017

Sources for this page

Every dataset that contributed a fact to this page.
Dataset Agency Used for
NDC Directory FDA Identity, ingredients, strengths, forms, routes, labelers, packages
Drugs@FDA FDA Application, sponsor, submissions, review documents, marketing status
Orange Book FDA Therapeutic equivalence codes, reference drug flags, patents, exclusivity
Drug Labeling FDA / NLM Prescribing information reproduced above
FAERS FDA Adverse event report counts
Enforcement FDA Recall records

Generated September 25, 2026 · 13 sections on this page.