drug: clozapine

*

• Clinical class: antipsychotic
• Chemical class: tricyclic dibenzodiazepine
• Active metabolite: Norclozapine
• DEA schedule: none
• FDA Medwatch Consumer Advisory
• MEDLINEplus^® Drug Information

U.S. Preparations:

• clozapine (Caraco, Ivax, Mylan, Sandoz) FDA approved for treatment of: schizophrenia for the management of severely ill schizophrenic patients who fail to respond adequately to standard drug treatment for schizophrenia
• Clozaril^® (Novartis) FDA approved:
  9.26.1989 for the management of severely ill schizophrenic patients who fail to respond adequately to standard drug treatment for schizophrenia
  12.18.2002 for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for reexperiencing suicidal behavior, based on history and recent clinical state
  U.S. Prescribing information
• FazaClo® (Alamo Pharmaceuticals) FDA approved:
  2.9.2004 for the management of severely ill schizophrenic patients who fail to respond adequately to standard drug treatment for schizophrenia
  U.S. Prescribing information

Preparations Outside U.S.:

• Alemoxan, Klozapol, Leponex,

Stephen Stahl's Clinical Pearls* (Consult your physician before making any change in your treatment.)

• Most efficacious but most dangerous
• May reduce violence and aggression in difficult cases.
• May improve tardive dyskinesia.
• Reduces suicide in schizophrenia.
• Clinical improvements continue slowly over several years.
• Not a first-line/first-break treatment choice in most countries.
• Can cause agranulocytosis (0.5%-2%).
• Monitoring of blood counts necessary weekly for six months, and then every two weeks.
• Increased risk of seizures related to dose.
• Doses over 550 mg/day may require concomitant anticonvulsant.
• Can cause significant weight gain.
• Sedation and sialorrhea (especially at night) may be bothersome.

• A Christmas Tale Catherine Deneuve, Jean-Paul Roussillon, and Anne Consigny 2008

*Reprinted with permission from: Stahl, Stephen M Psychopharmacology of Antipsychotics Paperback 1999 Martin Dunitz, Ltd You cannot fully appreciate this book until you have seen the extraordinary illustrations of every aspect of this area of psychopharmacology and neurochemistry. Loaded with practical clinical "pearls."

*Molecule graphic courtesy of Steve Chapman

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