UnifiedACB

Medication evidence profile

Clozapine

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Clinical overview

Antipsychotic

Clozapine has public medication-list entries in JARS 2025, Yamada-ABS 2023, BAAS 2019, Swe-ABS 2023, GABS 2018, KABS 2020 open validation supplement, and CALS 2022 Table 4. These are 7 separate source versions, each with its own evidence and definitions.

Source-specific scores

SourceScore
JARS3
Yamada-ABS3
BAAS3
Swe-ABS3
GABS3
KABS3
CALS3

How to read this: 0 means the source explicitly assigned zero. “Not listed” means the source did not provide a score for this medication. Scores from different scales are not averaged.

How to interpret the evidence

7 of 7 public source versions contain an explicit medication-list entry for Clozapine.

The available rows for Clozapine display the same numeric value. Agreement of the displayed numbers does not establish identical methods, clinical meaning or patient-level risk.

None of the public rows in this profile is an explicit zero. An unlisted source still supplies no value.

Source labels and provenance · 7 observations
  1. Japanese Anticholinergic Risk Scale (JARS) 2025 English translation

    Source label: Clozapine. Published value: 3.
    Source version: JARS-2025
    Source location: RC4 source recovery; recovery_scope=primary_table_complete; ATC=N05AH02
    Observation: JARS_2025_R0031; rating state: published_rating.

  2. Yamada Pharmacological Anticholinergic Burden Scale 2023

    Source label: Clozapine. Published value: 3.
    Source version: YAMADA-ABS-2023
    Source location: RC4 source recovery; recovery_scope=primary_nonzero_complete
    Observation: YAMADA_ABS_2023_R0089; rating state: published_rating.

  3. Brazilian Anticholinergic Activity Scale 2019

    Source label: Clozapine. Published value: 3.
    Source version: BAAS-2019
    Source location: RC4 source recovery; recovery_scope=primary_table_complete
    Observation: BAAS_2019_R0016; rating state: published_rating.

  4. Swedish Anticholinergic Burden Scale 2023

    Source label: Clozapine. Published value: 3.
    Source version: SWE-ABS-2023
    Source location: RC4 source recovery; recovery_scope=primary_final_nonzero_complete
    Observation: SWE_ABS_2023_R0088; rating state: published_rating.

  5. German Anticholinergic Burden Score 2018

    Source label: Clozapine. Published value: 3.
    Source version: GABS-2018
    Source location: RC4 source recovery; recovery_scope=primary_nonzero_complete
    Observation: GABS_2018_R0128; rating state: published_rating.

  6. KABS 2019 scale - 2020 open validation supplement

    Source label: Clozapine. Published value: 3.
    Source version: KABS-2020-validation-supplement
    Source location: Additional file 1; category Antipsychotics; table row 44
    Observation: KABS2020_SUPP_0191; rating state: published_validation_supplement_rating.

  7. CALS 2022 - primary final Table 4

    Source label: Clozapine. Published value: 3.
    Source version: CALS-2022-primary-table4
    Source location: Table 4; literal capture row 118; displayed table row 17; displayed column 6
    Observation: CALS2022_T4_0118; rating state: published_final_table_rating.

Class context — antipsychotics

The antipsychotics in this overlay are included in the AGS strong-anticholinergic reference list, while the broader Beers antipsychotic criterion is indication- and context-dependent. Do not reduce this relationship to a single medication-level yes/no safety label.

AGS Beers 2023 Table 2; AGS Beers 2023 Table 3; AGS Beers 2023 Table 7

Clozapine: medication-specific notes

Parkinson disease exception

Within the Parkinson disease criterion, clozapine is identified as one of the antipsychotic exceptions that appears less likely to worsen Parkinson disease than most other antipsychotics. This does not erase other antipsychotic or anticholinergic considerations.

AGS Beers 2023 Table 3

Older-adult medication context

AGS Beers context: classification and criteria

AGS Beers 2023 · Strong anticholinergic
  • Table 7: Strong-anticholinergic reference listing.
  • Table 2: The antipsychotic criterion contains indication-based exceptions; interpretation requires the current indication.

Source-scale observations and geriatric criteria answer different questions. The Beers material does not alter any score above.

Adults 65 years and older; intended for ambulatory, acute, and institutional care except hospice/end-of-life settings.

Condition-specific and medication-combination contexts

Table 3: clinical conditions

Condition-specific contexts: delirium or high delirium risk, dementia or cognitive impairment, and history of falls or fractures. Applicability depends on the condition and the relevant source criterion.

Table 5: cumulative anticholinergic exposure

Concurrent use of more than one anticholinergic medication should be minimized because cumulative exposure increases geriatric safety concerns.

American Geriatrics Society 2023 updated AGS Beers Criteria — Tables 2, 3, 5 and 7; selected criterion context.

Potentially inappropriate does not mean absolutely contraindicated. Apply the criterion in clinical context and use shared decision-making.

What this page does not establish

  • All public source versions represented by this release have an entry for this medication. Coverage of this selected source set does not establish complete evidence for every population or formulation.
  • No route inference unless present in the source label.
  • These source records do not estimate an individual’s probability of harm or establish whether to start, stop or change a medication. Ordinal source scores are not averaged into a UnifiedACB score.
Why is this medication clinically relevant to anticholinergic burden?Is this medication identified in the 2023 AGS Beers Criteria?What geriatric concerns are most relevant for this medication?
What is the clozapine exception in the Parkinson disease criterion?

References

  1. Mizokami F, Mizuno T, Taguchi R, et al. Development of the Japanese Anticholinergic Risk Scale: English translation of the Japanese article. Geriatr Gerontol Int. 2025;25(1):5-13. doi:10.1111/ggi.15001. Open source
  2. Yamada S, Mochizuki M, Chimoto J, Futokoro R, Kagota S, Shinozuka K. Development of a pharmacological evidence-based anticholinergic burden scale for medications commonly used in older adults. Geriatr Gerontol Int. 2023;23(7):558-564. doi:10.1111/ggi.14619. Open source
  3. Nery RT, Reis AMM. Development of a Brazilian anticholinergic activity drug scale. Einstein (Sao Paulo). 2019;17(2):eAO4435. doi:10.31744/einstein_journal/2019AO4435. Open source
  4. Rube T, Ecorcheville A, Londos E, Modig S, Johansson P. Development of the Swedish anticholinergic burden scale (Swe-ABS). BMC Geriatr. 2023;23(1):518. doi:10.1186/s12877-023-04225-1. Open source
  5. Kiesel EK, Hopf YM, Drey M. An anticholinergic burden score for German prescribers: score development. BMC Geriatr. 2018;18(1):239. doi:10.1186/s12877-018-0929-6. Open source
  6. Suh Y, Ah YM, Han E, et al. Dose response relationship of cumulative anticholinergic exposure with incident dementia: validation study of Korean anticholinergic burden scale. BMC Geriatr. 2020;20(1):265. doi:10.1186/s12877-020-01671-z. Open source
  7. Ramos H, Moreno L, Pérez-Tur J, Cháfer-Pericás C, García-Lluch G, Pardo J. CRIDECO Anticholinergic Load Scale: an updated anticholinergic burden scale. Comparison with the ACB Scale in Spanish individuals with subjective memory complaints. J Pers Med. 2022;12(2):207. doi:10.3390/jpm12020207. Open source

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Medication context: Clozapine

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