More tools of the titration trade with a focus on anmoxatine, ziprasidone, and quatiope.

Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Akin, the editor-in-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsome, a psychiatric MP and a dedicated reader of every issue.

Today, we cover two medications where rapid titration can cause a dangerous inflammatory

reaction, Clozapine and Lomotrogen.

We follow it with a research update on propanolol in panic disorder.

Textbooks have always recommended a slow titration with clausopine, starting at 12.5 or 25 milligrams a day in divided doses, and raising by increments of 25 to 50 milligrams.

That wisdom is still true, but we now have a better

understanding of why. We used to think it was to prevent low blood pressure on the drug. We now know

that slow titration of clausopine also prevents inflammatory reactions, allergies. When some medications are started too high,

the body reads it as an attack, a foreign invader, like an allergy, and it responds with an

inflammatory cascade. With Lomotrogen, that can cause severe skin rashes, hepatitis, and bleeding.

With clasapine, that inflammatory reaction affects the heart,

which gets inflamed with myocarditis.

Other inflammatory reactions are also possible with clausopine.

There's interstetial nephritis in the kidneys, colitis, hepatitis,

as well as isolated fever, and eosinophilia.

And even if you titrate clausapine slowly, you can still run into trouble, such as if you give it with a strong CYP 1A2 inhibitor, which will triple Clauseapine's levels.

Fortunately, there is only one strong CYP-1-A-2 inhibitor you need to watch for in psychiatry,

fluvoxamine luvox.

Some authors recommend monitoring for inflammation while starting clausapine, such as by checking

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