Pharm
Clozapine
search
Clozapine
, Clozaril
See Also
Antipsychotic Medication
Psychosis
Class
Atypical Antipsychotic
(Second
Gene
ration agent)
Neuroleptic
Dibenzodiazepine
Antipsychotic
Precautions
Not a first line
Antipsychotic
: See Disadvantages below
Only providers in Clozapine
REMS
Program can prescribe
Each patient on Clozapine must be registered with the program
Requires regular submission of
Absolute Neutrophil Count
s
FDA black box warnings
Agranulocytosis
Seizure
risk,
Myocarditis
Orthostatic Hypotension
Increased mortality in elderly
Indications
Refractory
Schizophrenia
Suicidal behavior in
Schizophrenia
Psychosis
in the elderly (not FDA approved)
Bipolar Disorder
(not FDA approved)
Dosing
Adults
Initial: 12.5 mg PO qd or bid
Titrate slowly upwards in increments of 25-50 mg/day
Target dosing: 300-450 mg/day
Maximum dose: 900 mg/day
Elderly
Initial: 6.5 PO qd
Titrate slowly upwards in increments of 25 mg/day
Maximum dose: 450 mg/day
Cost
Even generic costs >$250 per month
Disadvantages
Agranulocytosis
has high mortality
Higher risk of
Diabetes Mellitus
and weight gain
Hypertriglyceridemia
Adverse Effects
Anticholinergic Symptoms
Agranulocytosis
Hypotension
(alpha-
Adrenergic Receptor
blockade)
Tachycardia
Hyperthermia
Hyperglycemia
including development of
Diabetes Mellitus
Seizure
s
Sialorrhea
Weight gain
Sedation
Drug Interactions
Increase
Antipsychotic
levels (toxicity risk): Monitor for toxicity
Grapefruit
juice
Caffeine
Cimetidine
Ciprofloxacin
Citalopram
Erythromycin
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Decrease
Antipsychotic
levels (lower efficacy)
Barbiturate
s
Carbamazepine
Phenytoin
Nicotine
Rifampin
Monitoring
See
Antipsychotic
Absolute Neutrophil Count
s
Resources
Clozapine
REMS
Program
https://www.clozapinerems.com/CpmgClozapineUI/home.u
References
(2015) Presc Lett 22(11): 65
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