Clozapine

Details About Generic Salt ::  Clozapine 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Psychotics

1E. ANTI-PSYCHOTICS in 1. NERVOUS SYSTEM
CLOZAPINE
DOPAMINE RECEPTOR BLOCKER | ANTI-PSYCHOTIC
PK: A: Well absorbed M: Hepatic E: Urine, feces

Indications & Dose: TREATMENT-REFRACTORY SCHIZOPHRENIA PO Adult Initially 12.5mg BID/TID, increased in increments of 25-50mg/day to target dose 300-450mg/day after 2 wk, may further titrate in increments not exceeding 100mg & no more frequently than once/twice weekly, max dose 900mg/day Child 12-18 yr: 12.5mg OD/BID on 1st day then 25-50mg on 2nd day, if tolerated increase by 25-50mg/day over 2-3 wk up to 300mg/day in divided doses. If needed further increase by 50-100mg once (preferably)/ twice weekly, usual dose 200-450mg/day, max 900mg/day Elderly Initially 12.5-2mg/day increased by 25mg/day to desired response | TREATMENT-RESISTANT PSYCHOSES IN PARKINSON’S DISEASE PO Adult Initially 12.5mg/day HS, daily dosage may be increased by 12.5mg up to twice a week, a dose of 50mg/day should not be reached before the end of the 2nd wk, usual dose 25- 37.5mg/day

Contra: Hypersensitivity, history of agranulocytosis, uncontrolled epilepsy, paralytic ileus, myeloproliferative disorders, bone marrow suppression, abnormalities of WBC count/differential blood count, severe renal impairment, history of drug-induced neutropenia, uncontrolled epilepsy, alcoholic/toxic psychoses, drug intoxication, history of circulatory collapse

Precautions: History of seizures, hepatic impairment, cardiac impairment, prostatic hypertrophy, intestinal obstruction, paralytic ileus, angle-closure glaucoma, elderly, DM

ADR: Serious: NMS, myocarditis, respiratory arrest, autonomic disturbances, blood disorders, seizures, SJS, blurred vision, tardive dyskinesia, tremor, parkinsonism, syncope, hypotension, tachycardia, ECG changes, EPS, Others: sedation, drowsiness, dizziness, vertigo, headache, insomnia, nightmares, agitation, lethargy, fatigue, slurred speech, depression, nasal congestion, sinusitis, nausea, vomiting, dyspepsia, salivation, urinary frequency & urgency, urinary incontinence, dyspnea, muscle spasms, rigidity, sweating, weight gain, fever

DDI: Serious Nitrofurantoin/Cotrimoxazole/Olanzapine decreases WBC count, Carbamazepine drug serum levels are halved & leads to fatal pancytopenia, NMS, Valproic acid increase or decrease drug levels, Fluvoxamine/Fluoxetine/Paroxetine/Sertraline increases drug level, Ciprofloxacin increases drug level & causes drug toxicity, Hormonal Contraceptives increases drug levels & its adverse effects, Cimetidine increases drug levels & its toxicity, Antihypertensives leads to additive hypotensive effects, Antimuscarinics leads to urinary retention & delirium, Phenobarbital/Omeprazole/Phenytoin reduces drug levels, Benzodiazepines severe hypotension, respiratory depression, unconsciousness & respiratory arrest

Diet: With/without food

Monitor: Mental status, ECG, WBC, vital signs, fasting lipid profile and FBG/Hgb A1c, LFT, BMI

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