Clozapine: Difference between revisions

(new page)
 
 
(21 intermediate revisions by 8 users not shown)
Line 1: Line 1:
==Background==
==General==
*Atypical antipsychotic
*Type: Atypical [[antipsychotic]]
*Dosage Forms:
**12.5, 25, 50, 100, 200
**12.5, 25, 50, 100, 150, 200 ODT
*Common Trade Names: Clozaril, FezaClo, Versacloz
 
==Adult Dosing==
===[[Schizophrenia]], resistant===
*150-300mg PO BID
*start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days;
*max 900mg/day
*retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d
*taper dose over 1-2 weeks to DC
 
===Suicide prevention, schizophrenia-associated===
*150-300mg PO BID
*start, increase, retitrate, and DC as above
 
==Pediatric Dosing==
*Schizophrenia (limited data - adjusted dose based on tolerability, clinical response)
** Children >6 years PO 6.25 or 12.5mg qd
** Adolescents 12.5mg 1-2x daily
 
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B (no evidence of risk)
*Lactation: possibly unsafe
*Renal Dosing
**Adult
***not defined, consider decreasing dose for significant impairment
**Pediatric
***not available
*Hepatic Dosing
**Adult
***not defined, consider decreasing dose for significant impairment
**Pediatric
***not available
 
==Indications==
*Controls positive and negative symptoms of psychotic disorders
*Controls positive and negative symptoms of psychotic disorders
*Used for schizophrenia
*Off label use:
**Bipolar disorder
**Borderline personality disorder
==Contraindications==
*Allergy to class/drug
*history of clozapine-associated myocarditis
*history of agranulocytosis or granulocytopenia
*uncorrected electrolyte abnormalities
*caution in elderly, stroke, dementia, CAD, prolonged QT
*caution if history of torsades de pointes, ventricular arrhythmias
*caution if bradycardic, recent MI, CHF
*caution if eosinophila
*caution if pulmonary disease, hepatic impairment, seizure risk
*caution if BPH, angle-closure glaucoma, DM
*caution if PKU


==Complications==
==Adverse Reactions==
*QT Prolongation
*[[QT prolongation]]
*Agranulocytosis in 1%–2% of patients during initial treatment 3 months  
*[[Myocarditis]]
*[[Agranulocytosis]] in 1%–2% of patients during initial treatment 3 months  
**Highest ~3 months into treatment and then decreases  
**Highest ~3 months into treatment and then decreases  
*Other potential side effects:
*Other potential side effects:
Line 11: Line 65:
**Diabetes
**Diabetes
**Decreased seizure threshold
**Decreased seizure threshold
*"Other adverse cardiovascular and respiratory effects" <ref name="FDA">"Clozaril (Clozapine) drug description - FDA approved labeling for prescription drugs and medications at RxList". Rxlist.com. Retrieved 2008-10-09.</ref>
*"Increased mortality in elderly patients with dementia-related psychosis"<ref name="FDA" />
==Pharmacology==
*Half-life:  4-66h
*Metabolism:  liver extensively
*Excretion: urine 50%, feces 30%
*Mechanism of Action: exact mechanism of action unknown, antagonizes dopamine D2, serotonin 5-HT2, α adrenergic, cholinergic muscarinic receptors, others


==Also See==
==See Also==
*[[Schizophrenia]]
*[[Schizophrenia]]
*[Antipsychotic Medications]
*[[Bipolar disorder]]
*[[Borderline personality disorder]]
*[[Antipsychotics]]
*[[Antipsychotic toxicity]]


==Sources==
==References==
*Lange Poisoning and Drug Overdose, 6th Ed., p. 443-4, 160-162
<references/>


[[Category:Psych]]
[[Category:Pharmacology]]
[[Category:Psychiatry]]

Latest revision as of 04:08, 7 March 2021

General

  • Type: Atypical antipsychotic
  • Dosage Forms:
    • 12.5, 25, 50, 100, 200
    • 12.5, 25, 50, 100, 150, 200 ODT
  • Common Trade Names: Clozaril, FezaClo, Versacloz

Adult Dosing

Schizophrenia, resistant

  • 150-300mg PO BID
  • start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days;
  • max 900mg/day
  • retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d
  • taper dose over 1-2 weeks to DC

Suicide prevention, schizophrenia-associated

  • 150-300mg PO BID
  • start, increase, retitrate, and DC as above

Pediatric Dosing

  • Schizophrenia (limited data - adjusted dose based on tolerability, clinical response)
    • Children >6 years PO 6.25 or 12.5mg qd
    • Adolescents 12.5mg 1-2x daily

Special Populations

  • Pregnancy Rating: B (no evidence of risk)
  • Lactation: possibly unsafe
  • Renal Dosing
    • Adult
      • not defined, consider decreasing dose for significant impairment
    • Pediatric
      • not available
  • Hepatic Dosing
    • Adult
      • not defined, consider decreasing dose for significant impairment
    • Pediatric
      • not available

Indications

  • Controls positive and negative symptoms of psychotic disorders
  • Used for schizophrenia
  • Off label use:
    • Bipolar disorder
    • Borderline personality disorder

Contraindications

  • Allergy to class/drug
  • history of clozapine-associated myocarditis
  • history of agranulocytosis or granulocytopenia
  • uncorrected electrolyte abnormalities
  • caution in elderly, stroke, dementia, CAD, prolonged QT
  • caution if history of torsades de pointes, ventricular arrhythmias
  • caution if bradycardic, recent MI, CHF
  • caution if eosinophila
  • caution if pulmonary disease, hepatic impairment, seizure risk
  • caution if BPH, angle-closure glaucoma, DM
  • caution if PKU

Adverse Reactions

  • QT prolongation
  • Myocarditis
  • Agranulocytosis in 1%–2% of patients during initial treatment 3 months
    • Highest ~3 months into treatment and then decreases
  • Other potential side effects:
    • Dyslipidemia
    • Diabetes
    • Decreased seizure threshold
  • "Other adverse cardiovascular and respiratory effects" [1]
  • "Increased mortality in elderly patients with dementia-related psychosis"[1]

Pharmacology

  • Half-life: 4-66h
  • Metabolism: liver extensively
  • Excretion: urine 50%, feces 30%
  • Mechanism of Action: exact mechanism of action unknown, antagonizes dopamine D2, serotonin 5-HT2, α adrenergic, cholinergic muscarinic receptors, others

See Also

References

  1. ↑ 1.0 1.1 "Clozaril (Clozapine) drug description - FDA approved labeling for prescription drugs and medications at RxList". Rxlist.com. Retrieved 2008-10-09.
Retrieved from "https://www.wikem.org/w/index.php?title=Clozapine&oldid=299841"