Clozapine Side Effects

clozapine side effects

Clozapine is a drug for schizophrenia patients who are not responsive to or intolerant of classical anti psychotics. Non-responsiveness here means a lack of satisfactory clinical improvement after adequate doses of at least two antipsychotics for enough durations. The definition of intolerance is the improbability of reaching clinical benefit after classical antipsychotic using because of a serious neurological side effects, such as extrapiramidal syndrome or dyskinesia.

The use of clozapine can reduce the risk of recurrent suicidal behavior in patients with schizophrenia who are at high risk for re-experiencing suicidal behavior. 

Clozapine dosage

Clozapine is an oral drug. The dosage must be given individually. The lowest effective dose must be maintained for each patient. 

• To begin therapy, dosage of clozapine is 12.5 mg once or twice in the first day, then 25 mg on the second day. 
• For elderly: only12.5 mg once (for the first day). Doses may be added for only maximum 25 mg/day.
• Maximum permissible dose is 900 mg/day. The possibility of increased clozapine side effects (such as: seizure) occuring at dosage of more than 450 mg/day.
• To terminate the therapy, a gradual reduction should be done over 1 to 2 weeks period. Patients should be monitored for recurrence of psychotic symptoms and cholinergic rebound such as headache, nausea, sweating, vomiting, and diarrhea.

Clozapine side effects

According to MIMS-UBM Medica, clozapine side effects are:

• Agranulocytosis. Clozapine and agranulocytosis are proven related. Drugs known to have a potential to depress bone marrow function such as chloramphenicol, cotrimoxazole, analgesics, penicillamine, and carbamazepine must not be used simultaneously with clozapine.
• The most common disorders: fatigue, over sweating, hyperthermia.  
• Psychiatric disorder (rare): restlessness, agitation
• Metabolic disorder: weight gain (very common), mild increased of blood glucose, hypercholesterol.
• Brain and nerve disorder (common): sedation, dizziness, headache, tremor, blurred vision, seizure, confusion, delirium.
• Cardiac disorder (very common): tachycardia, arrythmia, hypertension, syncope.
• Gastrointestinal disorder (very common): hypersalivation, constipation, nausea, vomiting, dry mouth.
• Reproductive disorder: priapism