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Asian patients need half the clozapine dose (D) used in the United States to get the same blood concentrations (C). The concentration\u2010to\u2010dose (C\/D) ratio measures drug clearance. In the United States, the average clozapine patient usually needs from 300 to 600\u2009mg\/day to reach 350\u2009ng\/mL. US male smokers reach this therapeutic C with a D of 600\u2009mg\/day (C\/D ratio of 0.60 = 600\/350), whereas US female nonsmokers usually need a D of 300\u2009mg\/day (C\/D ratio of 1.17 = 300\/350). While in the United States, average CLO C\/D ratios typically are 0.6\u20101.2 ng\/mL per mg\/day, in Asian populations they range from 1.20 in male smokers to 2.40 in female smokers, requiring Ds of 300 to 150\u2009mg\/day to obtain 350\u2009ng\/mL. Asian patients can become clozapine poor metabolizers (PMs), needing very low Ds (50\u2010150\u2009mg\/day) to get therapeutic Cs, by taking inhibitors (fluvoxamine, oral contraceptives and valproic acid), due to obesity, or during inflammations with systemic effects. In 573 Asian patients from five samples, around 1% were PMs due to taking inhibitors, 1% due to inflammation, 1% due to obesity, and 7% were potential genetic PMs. The potential genetic PMs ranged between 3% and 13%, but this prevalence will have to be better established in future studies including genetic testing for possible CYP1A2 mutations, which may explain PM status.<\/jats:p>","DOI":"10.1111\/appy.12384","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T17:53:57Z","timestamp":1583171637000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Using therapeutic drug monitoring to personalize clozapine dosing in Asians"],"prefix":"10.1111","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7756-2314","authenticated-orcid":false,"given":"Jose","family":"de Leon","sequence":"first","affiliation":[{"name":"Mental Health Research Center, Eastern State Hospital  Lexington Kentucky"},{"name":"Psychiatry and Neurosciences Research Group (CTS\u2010549), Institute of Neurosciences, University of Granada  Granada Spain"},{"name":"Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Ap\u00f3stol Hospital, University of the Basque Country  Vitoria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Schoretsanitis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Research Zucker Hillside Hospital, Northwell Health, Glen Oaks  New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Kane","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Research Zucker Hillside Hospital, Northwell Health, Glen Oaks  New York"},{"name":"Department of Psychiatry and Molecular Medicine Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead  New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can\u2010Jun","family":"Ruan","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Psychopharmacology &amp; The National Clinical Research Centre for Mental Disorders &amp; Beijing Key Lab of Mental Disorders Beijing Anding Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2003.01858.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15f10514"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2015.01.042"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2019.05.033"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000001050"},{"key":"e_1_2_9_7_1","volume-title":"Clinical pharmacokinetics handbook","author":"Bauer L. 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