The Brand Name REFRACT Has Generic Salt :: Clozapine 

REFRACT  Is From Company Crescent Th. Priced :: Rs. 20.00/35.00/60.00

REFRACT have Clozapine is comes under Sub class Anti Psychotics of  Main Class Nervous System

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

Indications for Drugs ::

Schizophrenia in people for whom other antipsychotic medicines are ineffective or not tolerated. Psychotic disorders in people with Parkinson’s disease, when standard treatment has failed to control symptoms.

Drug Dose ::

Adult over 16 years: PO: Schizophrenia 12.5 mg 1-2 times on day 1(elderly 12.5 mg once), followed by 25-50 mg 1-2 times on day 2(elderly 25-37.5 mg). Increase gradually according to response over 14-21 days up to 300 mg daily in divided doses (larger dose at night, up to 200 mg daily may be taken as a single dose at bedtime); if necessary may be further increased in steps of 50-100 mg once (preferably) or twice weekly; Usual range: 200-450 mg/day. Max: 900 mg/day. Psychoses in Parkinson’s disease Initial: 12.5 mg/day at night, increase gradually in steps of 12.5 mg up to twice weekly. Usual range: 25-37.5 mg/day at bedtime. Max: 100 mg/day in 1-2 divided doses. Elderly: Initially, 12.5 mg on day 1 increased subsequently by increments of 25 mg. Hepatic impairment: Use with caution and avoid in symptomatic or progressive liver disease or hepatic failure.

Contraindication ::

History of bone marrow disorders including agranulocytosis, circulatory collapse, alcoholic or toxic psychosis, drug intoxication, uncontrolled epilepsy, severe renal, hepatic or cardiac disease; paralytic ileus. Pregnancy and lactation.

Drug Precautions ::

Medication should not be stopped abruptly; should be tapered off over 1-2 weeks. If conditions warrant abrupt discontinuation (leukopenia, myocarditis, cardiomyopathy), monitor patient for psychosis and cholinergic rebound (headache, nausea, vomiting, diarrhea). Elderly patients are more susceptible to adverse effects (including agranulocytosis, cardiovascular, anticholinergic, and tardive dyskinesia). Significant risk of agranulocytosis, potentially life-threatening. Leucocyte counts should be monitored regularly and for at least 4 wk after treatment discontinuation. Renal, hepatic or cardiac impairment; prostatic enlargement, narrow-angle glaucoma; elderly; immobilised patients

Drug Side Effects ::

Drowsiness, dizziness, headache; nausea, vomiting, constipation; anxiety, confusion, fatigue, transient fever. Rarely, dysphagia, acute pancreatitis, cholestatic jaundice; orthostatic hypotension, tachycardia; seizures; hypersalivation.Potentially Fatal: Rarely, thromboembolism. Reversible neutropenia which may progress to a potentially fatal agranulocytosis. Fatal myocarditis.

Pregnancy category ::

2

Drug Mode of Action ::  

Clozapine has relatively weak dopamine receptor-blocking activity at D1, D2, D3 and D5 receptors but has high affinity for the D4 receptor. It has also blocking effects on serotonin, ?-adrenergic histamine H1 and cholinergic receptors.

Drug Interactions ::

Increased risk and/or severity of bone marrow suppression w/ bone marrow suppressants (e.g. carbamazepine, chloramphenicol), sulfonamides (e.g. co-trimoxazole), pyrazolone analgesics (e.g. phenylbutazone), penicillamine, cytotoxic agents or long-acting depot inj of antipsychotics. Concomitant use w/ benzodiazepines may increase risk of circulatory collapse which may lead to cardiac and/or resp arrest. Additive CNS depression and cognitive and motor performance interference w/ MAOIs and CNS depressants including antihistamines, benzodiazepines and opioid analgesics. May potentiate effects of anticholinergics or antihypertensives. Increased plasma concentration of highly protein bound substances (e.g. warfarin, digoxin). Decreased plasma concentrations w/ phenytoin. Concomitant use w/ lithium can increase the risk of development of neuroleptic malignant syndrome. Decreased clozapine levels w/ CYP1A2 inducers (e.g. omeprazole). Increased clozapine levels w/ CYP1A2 inhibitors (e.g. fluvoxamine, caffeine, ciprofloxacin).