Clozapine - Revision history

Zeki at 02:11, 22 July 2024

2024-07-22T02:11:39Z

Helen at 02:47, 28 December 2020

2020-12-28T02:47:51Z

← Older revision		Revision as of 22:47, 27 December 2020
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	[[Category: Drugs]][[Category: Antipsychotics, typical; Antipsychotic 2nd Generation]]		[[Category: Drugs]][[Category: Antipsychotics, typical; Antipsychotic 2nd Generation]]
	'''Clozapine''' (中文:[[ ]])is an atypical antipsychotic or 2nd Generation antipsychotic medication. It is specifically used to treat treatment resistant schizophrenia (TRS), which affects approximately 1 in 3 people with the condition. These people include those who:		'''Clozapine''' (中文:[[氯氮平]])is an atypical antipsychotic or 2nd Generation antipsychotic medication. It is specifically used to treat treatment resistant schizophrenia (TRS), which affects approximately 1 in 3 people with the condition. These people include those who:
	*Have tried at least 2 other antipsychotic medications that did not work		*Have tried at least 2 other antipsychotic medications that did not work
	*Are unable to tolerae other antipsychotics because of their side-effects		*Are unable to tolerae other antipsychotics because of their side-effects

Helen at 02:45, 3 November 2020

2020-11-03T02:45:08Z

← Older revision		Revision as of 22:45, 2 November 2020
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	===Driving and skilled tasks===		===Driving and skilled tasks===
	Drivers and machine operators should be told about the risk of drowsiness with this medication especially at the start of treatment. Affected patients should not drive or operate machinery.		Drivers and machine operators should be told about the risk of drowsiness with this medication especially at the start of treatment. Affected patients should not drive or operate machinery.

			==FAQ==
			===How should I take the tablet?===
			You will be prescribed the lowest dose needed to control your symptoms. The tablet should be swallowed whole with a glass of water. It is important to keep taking the tablet even if your symptoms improve or completely disappear. If you stop taking clozapine, your symptoms could come back.
			===How will I know that clozapine is working?===
			You may experience some, or all, of the following:
			*You feel better, becoming less withdrawn and more involved in life around you
			*Your ability to concentrate improves
			*Your relationships improve and you find it easier to mix with people
			*You may feel less aggressive and more able to control your anger
			=== What should I avoid while taking?===
			Avoid drinking alcohol while taking clozapine because it may enhance the side effects of sedation.
			Changing your smoking habits and the amount of caffeine you drink (in things such as tea, coffee or cola) can affect the amount of clozapine in your blood. Mention any such changes to your doctor.
			===What happen if I overdose?===
			Contact your primary care doctor.
			If emergency situation, call 999
			===What happen if I miss a dose?===
			Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Helen: /* Drug Management */

2020-11-03T02:43:17Z

Drug Management

← Older revision		Revision as of 22:43, 2 November 2020
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	\|An increased risk of ventricular arrhythmias – avoid concomitant use.		\|An increased risk of ventricular arrhythmias – avoid concomitant use.
	\|}		\|}

			===Caution===
			*age over 60 years
			*prostatic hypertrophy
			*susceptibility to angle-closure glaucoma
			*taper off other antipsychotics before starting

			===Contra-indications===
			*Severe cardiac disorders (e.g. myocarditis;
			*History of neutropenia or agranulocytosis;
			*Bone-marrow disorders
			*Paralytic ileus;
			*Alcoholic and toxic psychoses
			*History of circulatory collapse
			*Drug intoxication
			*Coma or severe CNS depression
			*Uncontrolled epilepsy

			===Hepatic impairment===
			*Avoid in symptomatic liver disease
			*Avoid in progressive liver disease
			*Avoid in hepatic failure
			*Monitor hepatic function regularly

			===Renal impairment===
			avoid in severe impairment

			===Pregnancy===
			use with caution

			===Breast-feeding===
			Use during breast feeding should be avoided.

			===Driving and skilled tasks===
			Drivers and machine operators should be told about the risk of drowsiness with this medication especially at the start of treatment. Affected patients should not drive or operate machinery.

Helen: /* Drug Management */

2020-11-03T02:41:05Z

Drug Management

← Older revision		Revision as of 22:41, 2 November 2020
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	On planned withdrawal reduce dose over 1 – 2 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefully.		On planned withdrawal reduce dose over 1 – 2 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefully.

			===Drug interaction===
			Avoid concomitant use of clozapine with drugs that have a substantial potential for causing agranulocytosis.
			Aripiprazole is metabolized by multiple pathways involving the CYP2D6 and CYP3A4 enzymes but not CYP1A enzymes. Thus, no dosage adjustment is required for smokers.
			{\| class="wikitable"
			!style="text-align: left"\| Drugs given with clozapine
			!style="text-align: left"\| Potential Effect
			\|-
			\|style="text-align: left"\|
			*CNS-depressant drugs including alcohol, hypnotics, anxiolytics, sedative H1 antihistamines, central antihypertensives, baclofen, thalidomide and opioids.
			\|
			Potentiates the sedative effect.
			\|-
			\|style="text-align: left"\|
			*Lithium
			\|Increased risk of extrapyramidal side-effects and possibly neurotoxicity
			\|-
			\|style="text-align: left"\|
			*Metoclopramide
			\|Increased risk of extrapyramidal side-effects
			\|-
			\|style="text-align: left"\|
			*Strong CYP2D6 inhibitors such as quinidine, fluoxetine and paroxetine.
			\|May result in higher plasma concentrations of clozapine, increased risk of toxicity.
			\|-
			\|style="text-align: left"\|
			*Strong CYP3A4 inhibitors, such as itraconazole and HIV protease inhibitors
			\|May result in higher plasma concentrations of clozapine, increased risk of toxicity.
			\|-
			\|style="text-align: left"\|
			*Strong CYP3A4 inducers, such as carbamazepine, rifampicin, phenytoin, phenobarbitone and St John’s Wort.
			\|May lower plasma concentrations of aripiprazole, so should increase clozapine dose.
			\|-
			\|style="text-align: left"\|
			*Drugs that prolong the QT interval e.g. amiodarone, sotalol, quinidine, flecainide
			*Drugs which induce bradycardia e.g. diltiazem, verapamil
			*Drugs which can cause hypokalaemia such as diuretics e.g. frusemide
			\|An increased risk of ventricular arrhythmias – avoid concomitant use.
			\|}

Helen: /* Drug Management */

2020-11-03T02:37:05Z

Drug Management

← Older revision		Revision as of 22:37, 2 November 2020
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	*Fasting blood glucose should be measured at baseline, at 4-6 months, and then yearly.		*Fasting blood glucose should be measured at baseline, at 4-6 months, and then yearly.
	'''Treatment Cessation'''		'''Treatment Cessation'''

	On planned withdrawal reduce dose over 1 – 2 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefully.		On planned withdrawal reduce dose over 1 – 2 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefully.

Helen at 02:36, 3 November 2020

2020-11-03T02:36:47Z

← Older revision		Revision as of 22:36, 2 November 2020
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	The elimination half-life is approximately 14 hours at steady state conditions.		The elimination half-life is approximately 14 hours at steady state conditions.
			\|}

	\|}		==Drug Management==
			===Monitoring===
			*clozapine requires white blood cell monitoring weekly for 18 weeks, then fortnightly for up to 1 year, and then monthly as part of the clozapine patient monitoring.
			*Close medical supervision during initiation (risk of collapse because of hypotension and convulsions).
			*Blood lipids and weight should be measured at baseline, and then at regular intervals.
			*Fasting blood glucose should be measured at baseline, at 4-6 months, and then yearly.
			'''Treatment Cessation'''
			On planned withdrawal reduce dose over 1 – 2 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefully.

Helen at 02:35, 3 November 2020

2020-11-03T02:35:17Z

@@ Line 149: / Line 149: @@
 !style="text-align: left"| Renal and urinary disorders
 |Common: urinary retention
 |}

Helen: /* Side Effects */

2020-11-03T02:33:56Z

Side Effects

← Older revision		Revision as of 22:33, 2 November 2020
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	!style="text-align: left"\| Eye disorders		!style="text-align: left"\| Eye disorders
	\|Common: blurred vision		\|Common: blurred vision
			\|-
	!style="text-align: left"\| Cardiac disorders		!style="text-align: left"\| Cardiac disorders
	\|		\|
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	*myocarditis		*myocarditis
	*pericarditis		*pericarditis
			\|-
	!style="text-align: left"\| Vascular disorders		!style="text-align: left"\| Vascular disorders
	\|		\|
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	*postural hypotension		*postural hypotension
	*hypertension		*hypertension
			\|-
	!style="text-align: left"\| Gastrointestinal disorders		!style="text-align: left"\| Gastrointestinal disorders
	\|		\|
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	*anorexia		*anorexia
	*dry mouth		*dry mouth
			\|-
	!style="text-align: left"\| Hepatobiliary disorders		!style="text-align: left"\| Hepatobiliary disorders
	\|		\|
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	*hepatitis		*hepatitis
	*cholestatic jaundice		*cholestatic jaundice
			\|-
	!style="text-align: left"\| Renal and urinary disorders		!style="text-align: left"\| Renal and urinary disorders
	\|Common: urinary retention		\|Common: urinary retention
	\|}		\|}

Helen at 02:32, 3 November 2020

2020-11-03T02:32:51Z

← Older revision		Revision as of 22:32, 2 November 2020
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	*1 in 3 people with TRS have an improvement within 6 weeks		*1 in 3 people with TRS have an improvement within 6 weeks
	*2 in 3 people with TRS have an improvement after one year of treatment.		*2 in 3 people with TRS have an improvement after one year of treatment.

			==Side Effects==
			Clozapine is associated with a relatively high risk of low white blood cells. It specifically affects a type of white blood cell called neutrophil. Neutrophils help the body to fight infections. A small fall in neutrophil levels leads to a condition called neutropenia, while a big fall is called agranulocytosis. Agranulocytosis and neutropenia are uncommon. However, if they occur, it is usually within the first 18 weeks of clozapine treatment.
			It is recommended that the white blood cell count be regularly monitored.

			All side-effects are listed by system organ and frequency:
			*Very common (≥ 1/10)
			*Common ( ≥ 1/100 to < 1/10)
			*Uncommon (≥ 1/1000 to < 1/100)
			*Rare (≥ 1/10,000 to < 1/1000)
			*Very rare (<1/10,000)

			{\| class = "wikitable"
			!style="text-align: left"\| Blood and lymphatic system disorders
			\|
			Common: neutropenia
			Uncommon: agranulocytosis
			Rare: anaemia
			Very rare: thrombocytopenia
			\|-
			!style="text-align: left"\| Metabolism and nutrition disorders
			\|
			Common: weight gain
			Rare: diabetes mellitus
			\|-
			!style="text-align: left"\| Psychiatric disorders
			\|Common: dysarthria
			\|-
			!style="text-align: left"\| Nervous system disorders
			\|
			Very common:
			*Drowsiness/sedation
			*Dizziness
			Common:
			*Seizures
			*Extrapyramidal symptoms
			*Akathisia
			*Tremor
			*Rigidity
			*headache
			Uncommon:
			*neuroleptic malignant syndrome
			Rare:
			*confusion
			*delirium
			\|-
			!style="text-align: left"\| Eye disorders
			\|Common: blurred vision
			!style="text-align: left"\| Cardiac disorders
			\|
			Very common: tachycardia
			Common: ECG changes
			Rare:
			*arrhythmias
			*myocarditis
			*pericarditis
			!style="text-align: left"\| Vascular disorders
			\|
			Common:
			*syncope
			*postural hypotension
			*hypertension
			!style="text-align: left"\| Gastrointestinal disorders
			\|
			Very common:
			*constipation
			*hypersalivation
			Common:
			*nausea
			*vomiting
			*anorexia
			*dry mouth
			!style="text-align: left"\| Hepatobiliary disorders
			\|
			Common: elevated liver enzymes
			Rare:
			*pancreatitis
			*hepatitis
			*cholestatic jaundice
			!style="text-align: left"\| Renal and urinary disorders
			\|Common: urinary retention
			\|}