In renal impairment dosing, Clozapine is dosed as: 156 mg on day 1, 117 mg on day 8, then monthly.

• A. 78 mg/month
• B. 156 mg on day 1, 117 mg on day 8, then 78 mg/month
• C. 52 mg/month
• D. 240 mg monthly

Answer: (B)

In renal impairment, dosing often uses a loading-to-maintenance approach: you give higher initial doses to rapidly reach effective levels, then switch to a lower maintenance dose to prevent accumulation as clearance is reduced.

Here, starting with a larger dose on day 1 helps quickly achieve therapeutic plasma concentrations. A subsequent dose on day 8 continues to push levels toward that target while beginning the taper. After the loading phase, dropping to a smaller monthly maintenance dose keeps the drug in the effective range without building up in the body given decreased renal clearance.

The other options don’t fit this pattern: some omit the loading steps or propose maintenance amounts that are either too high (risking toxicity) or too low to maintain efficacy.