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Anticipatory Clozapine Dosing After Discharge From Inpatient Treatment for the Patient With Comorbid Schizophrenia and Tobacco Use.

To the Editor: A lthough the pharmacological interaction between clozapine and tobacco smoke is well understood, there is no standard protocol available for guiding clinicians in managing this interaction. This important relationship needs to be considered when developing an effective outpatient treatment strategy for the hospitalized patient taking clozapine. Patients who stabilize on clozapine in a nonsmoking hospital setting are at risk of clinically worsening if they resume smoking after discharge. Here, we present a case and propose an approach to address this clinical challenge.