Outdated Product Labeling and Implications for Contemporary Standards of Care: The Example of Clozapine

Discontinuation of the U.S. Food and Drug Administration’s clozapine risk evaluation and mitigation strategy program led to a package insert (PI) revision in June 2025. However, that PI update retained many elements that are inconsistent with modern clozapine prescribing, including rapid titration, twice-daily dosing at the start of therapy, and titration without regard to patient factors (e.g., ancestry, sex and gender, or smoking status). The revision also provided no guidance on monitoring for myocarditis or mitigating the primary causes of mortality—pneumonia and ileus. This discrepancy between the clozapine PI and evidence-based practices has caused clinicians to consider whether deviation from the PI presents a medicolegal risk and how to cope with outdated PI information for clozapine and other medications. This article reviews the relative weight of different forms of medical evidence in establishing the standard of care, illustrates through case law that a PI does not define the standard of care and is inadmissible in malpractice litigation without expert testimony, and provides guidance for clinicians on how to navigate outdated, non–evidence-based PI recommendations. The information in this article should reassure clinicians that using modern evidence-based care—not archaic PI recommendations—is the optimal choice when treating patients.

Authors

Institutions

Publication Details

Journal
Psychiatric Services
Published
2026-10-22
DOI
https://doi.org/10.1176/appi.ps.20260173
Primary Topic
Medical Malpractice and Liability Issues
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Outdated Product Labeling and Implications for Contemporary Standards of Care: The Example of Clozapine

Jay W. Carruthers, Robert O. Cotes, Raymond C. Love, Deanna L. Kelly et al.
Psychiatric Services
Medical Malpractice and Liability Issues
article

Outdated Product Labeling and Implications for Contemporary Standards of Care: The Example of Clozapine

Jay W. Carruthers, Robert O. Cotes, Raymond C. Love, Deanna L. Kelly, Jonathan M. Meyer, Leon Ravin, Megan Ehret
article en

Abstract

Discontinuation of the U.S. Food and Drug Administration’s clozapine risk evaluation and mitigation strategy program led to a package insert (PI) revision in June 2025. However, that PI update retained many elements that are inconsistent with modern clozapine prescribing, including rapid titration, twice-daily dosing at the start of therapy, and titration without regard to patient factors (e.g., ancestry, sex and gender, or smoking status). The revision also provided no guidance on monitoring for myocarditis or mitigating the primary causes of mortality—pneumonia and ileus. This discrepancy between the clozapine PI and evidence-based practices has caused clinicians to consider whether deviation from the PI presents a medicolegal risk and how to cope with outdated PI information for clozapine and other medications. This article reviews the relative weight of different forms of medical evidence in establishing the standard of care, illustrates through case law that a PI does not define the standard of care and is inadmissible in malpractice litigation without expert testimony, and provides guidance for clinicians on how to navigate outdated, non–evidence-based PI recommendations. The information in this article should reassure clinicians that using modern evidence-based care—not archaic PI recommendations—is the optimal choice when treating patients.

Psychiatric Services
University of Maryland, Baltimore (US), Emory University (US), University of California San Diego (US), New York State Office of Mental Health (US), Nevada Division of Public and Behavioral Health (US)
Openalex Percentile: Top 7%
Medical Malpractice and Liability Issues
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.

Laika access coming soon
Outdated Product Labeling and Implications for Contemporary Standards of Care: The Example of Clozapine — Jay W. Carruthers, Robert O. Cotes, et al. · Psychiatric Services (2026) | TGRS Research Map | TGRS