How do you approach the use and titration of Cobenfy in patients with treatment refractory schizophrenia not responding to clozapine?  

This has to be managed carefully, given the anticholinergic effects.

It depends on what medications they are on. If they are on clozapine and you want to cross-titrate, then it will depend on the dose of clozapine and how fast you want to take it off, as we do not want cholinergic rebound. Let's say they are on clozapine 300 mg po qhs, then you can start Cobenfy at ...