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Clozaril
Clozaril (clozapine) is an atypical antipsychotic used to treat schizophrenia in patients who are resistant to other treatments or who experience recurrent suicidal behavior related to schizophrenia or schizoaffective disorder. Clozaril works by affecting several neurotransmitters in the brain, particularly dopamine and serotonin, to help manage symptoms such as hallucinations, delusions, and disordered thinking. Due to its unique side effect profile, Clozaril is reserved for patients who have not responded to other antipsychotic medications.
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Frequently Asked Questions
Why is Clozaril reserved for treatment-resistant schizophrenia?
Clozaril is associated with serious side effects like agranulocytosis and requires regular blood monitoring, so it’s used only when other antipsychotics fail.
How often do I need blood tests while on Clozaril?
Initially, blood tests are done weekly for the first six months, then biweekly for the next six months, and after that, monthly as long as the medication is continued.
Can Clozaril cause weight gain?
Yes, weight gain is a common side effect of Clozaril, along with increased appetite.
How long does it take for Clozaril to start working?
Some patients may notice improvements in symptoms within 1 to 2 weeks, but it may take 6 to 12 weeks for the full therapeutic effects.
Can I drink alcohol while taking Clozaril?
Alcohol can increase the sedative effects of Clozaril and should be avoided or used with caution.
Comprehensive Drug Guide
How Does Clozaril Work?
Clozaril primarily works by blocking dopamine D2 receptors and serotonin 5-HT2A receptors in the brain. By modulating these neurotransmitters, it helps reduce the psychotic symptoms associated with schizophrenia, while also minimizing the risk of motor side effects seen with typical antipsychotics.
Common Dosages
- Tablets of 25 mg, 50 mg, 100 mg, and 200 mg.
Typical Dosing
- For schizophrenia, the starting dose is 12.5 mg once or twice daily, gradually increased to a typical maintenance dose of 300 mg to 450 mg daily, split into multiple doses.
- Dosing adjustments are based on the patient’s response and tolerability, with a maximum dose of 900 mg per day.
Typical Dosing
FDA Approved Indications
- Treatment-resistant schizophrenia
- Recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder
Who Shouldn't Take Clozaril?
- Agranulocytosis or severe neutropenia
- Uncontrolled epilepsy
- Severe cardiovascular disease
- Known hypersensitivity to clozapine or any of its components.
Advice From The Pharmacist
- Patients taking Clozaril must enroll in a risk evaluation and mitigation strategy (REMS) program due to the risk of severe neutropenia.
- Regular blood tests are required to monitor white blood cell (WBC) counts and absolute neutrophil counts (ANC).
- Be aware of signs of infection, such as fever, sore throat, or flu-like symptoms, and seek immediate medical attention.
Side Effects of Clozaril
Common Side Effects
- Drowsiness
- Dizziness
- Weight gain
- Increased salivation
Uncommon/Severe Side Effects
- Agranulocytosis (dangerously low white blood cell count)
- Seizures
- Myocarditis (inflammation of the heart muscle)
- Orthostatic hypotension (drop in blood pressure when standing up)
Risks and Warnings of Clozaril
- Agranulocytosis: Clozaril can cause a severe drop in white blood cells, leading to a high risk of infection. Regular blood tests are required to monitor this.
- Seizure risk: Higher doses of Clozaril increase the risk of seizures.
- Cardiovascular risk: Clozaril can cause orthostatic hypotension and myocarditis, so patients with heart conditions should be closely monitored.
Interactions with Clozaril
Common Drug Interactions
- Antiepileptic drugs: Certain antiepileptic drugs can increase the risk of seizures.
- Benzodiazepines: Concomitant use with benzodiazepines can increase the risk of sedation and respiratory depression.
- Other antipsychotics: Combining Clozaril with other antipsychotics may increase the risk of side effects, including sedation and cardiovascular effects.
Alternatives to Clozaril
- Risperidone: Another atypical antipsychotic used to treat schizophrenia and bipolar disorder.
- Olanzapine: An antipsychotic used for schizophrenia and bipolar disorder, known for a lower risk of agranulocytosis compared to Clozaril.
- Aripiprazole: An atypical antipsychotic that also treats schizophrenia with a different side effect profile.
