OBJECTIVE Clozapine has been shown to be effective in the treatment of Parkinson disease psychosis and tremor; however, use of clozapine has been limited because of potential adverse effects and stringent monitoring criteria. METHODS To evaluate safety and efficacy in a naturalistic setting, we conducted a retrospective chart review of all patients ever treated with clozapine at a movement disorders clinic in Rhode Island. RESULTS Clozapine was indicated for psychosis in 39 patients, for tremor in 19, and for both tremor and psychosis in an additional 6 patients. Fifty of 61 patients reported improvement in their symptoms. Clozapine use was interrupted in 26 patients, for various reasons including transition to hospice care (3), worsening of motor symptoms (4), agranulocytosis (1), intolerable adverse effects (9), symptom resolution (2), and other or unknown reasons (7). CONCLUSIONS Clozapine may be useful in the management of movement disorders and related symptoms so long as adequate supervision and monitoring can be provided.