When, if ever, do you consider prescribing clozapine after only one unsuccessful antipsychotic trial in schizophrenia?

I recommend clozapine only after two adequate trials of antipsychotics, at least 6 weeks in duration, with 2 weeks at the maximum FDA-approved dose, with at least one blood level during the final two weeks as a check on compliance. I try to obtain these data because clozapine has such deleterious me...

This comes with experience. It depends on the level of psychosis as well as the dose of current antipsychotic being prescribed.

For example, if a patient is on Risperdal 4mg po bid and it doesn’t touch the psychosis then I’m thinking we need to try Zyprexa or Clozaril.

However, when you start Clozari...