Clozapine (Clozaril) and Ketamine Therapy | Tovani Health
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, the combination is depends on your specific situation. 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.