Clozapine and Ketamine: It Depends
Clozaril (Clozapine) (also: FazaClo) — Atypical antipsychotic (treatment-resistant schizophrenia)
Verdict at Tovani Health
Significant interaction surface; clozapine patients require careful evaluation.
Clozapine alongside ketamine requires individual evaluation. Clozapine has the largest interaction surface of any antipsychotic: heavy sedation, anticholinergic load, QT prolongation, orthostatic hypotension, and mandatory neutropenia monitoring (ANC checks). Patients on clozapine for treatment-resistant schizophrenia or schizoaffective disorder may still benefit from ketamine adjunctive therapy, but we coordinate closely with the prescribing psychiatrist.
If you take Clozaril regularly and are considering at-home ketamine therapy, eligibility depends on your specific situation — we evaluate case by case. This page covers the brief pharmacologic context and what we do at intake.
How Clozaril interacts with ketamine
Clozapine is a multi-receptor antagonist (D2, 5-HT2A, H1, M1, alpha-1) with the heaviest side-effect profile in the atypical class. CYP1A2-metabolized, so smoking cessation can spike levels.
What we do at intake
Disclose dose, indication, ANC status, and prescriber. Bring a recent EKG. We do not run at-home KAP for clozapine patients without close coordination with the treating team.
Bottom line
Clozapine alongside ketamine requires individual evaluation. Clozapine has the largest interaction surface of any antipsychotic: heavy sedation, anticholinergic load, QT prolongation, orthostatic hypotension, and mandatory neutropenia monitoring (ANC checks). Patients on clozapine for treatment-resistant schizophrenia or schizoaffective disorder may still benefit from ketamine adjunctive therapy, but we coordinate closely with the prescribing psychiatrist.
Frequently Asked Questions
Can ketamine help if I am on clozapine and still depressed?
Possibly. We evaluate individually and coordinate with your psychiatrist. Treatment-resistant patients are exactly who ketamine was developed for, but clozapine adds complexity.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Clozaril (Clozapine) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. Veraart JKE, Smith-Apeldoorn SY, Bakker IM, et al.. International Journal of Neuropsychopharmacology. 2021. PMID: 34170315
Systematic review of pharmacodynamic interactions between ketamine and psychiatric medications used in depression treatment.
- Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis. Alnefeesi Y, Chen-Li D, Krane E, et al.. Journal of Psychiatric Research. 2022. PMID: 35688035
Meta-analysis of 2,665 patients across 79 studies — 45% response and 30% remission with ketamine in treatment-resistant depression.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 16, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.