Clozapine in brief
Clozapine is an atypical antipsychotic –treatment of schizophrenia in ○ other agents cannot be tolerated- for e.g untreatable adverse reactions ○ treatment resistant patients psychosis in Parkinson’s disease- where standard treatment has failed
Mechanism of action –Works as antagonist across several receptors serotonin dopamine cholinergic muscarinic adrenergic histamine H1 weak D2 blocking activity
Common side effects include constipation weight gain hypersalivation malaise speech disorders urinary incontinence drowsiness/ sedation dizziness tachycardia
Agranulocytosis , neutropenia and potentially fatal agranuolcytosis reported. Leucocyte and differential WCC before starting FBC every week for 18 weeks Every 2 weeks after that Once stable for 1 year every 4 weeks
Seizures at high doses Cardiovascular and respiratory effects include ○ myocarditis ○ orthostatic hypotension ○ respiratory/ cardiac arrest particularly when administered with benzodiazepines or other psyhcotropic drugs Selective immunoglobulin M immunodeficiency
References
- British National Formulary ( BNF )
- Medicine compendium
- A Pocket Guide to Atypical Antipsychotics by Stephen M Stahl
- Effect of clozapine on immunoglobulin M plasma levels Roberto Lozano et al Ther Adv Psychopharmacol. 2016 Feb ;6 (1) ;58-60fever