antipsychotics (clozapine)

Question 1

What are the indications of clozapine?

Answer 1

treatment resistant schizophrenia, psychosis in parkinsons, tourettes, mania

Question 2

What are the contraindications of clozapine?

Answer 2

drug and toxic psychoses, comatose state, history of agranulocytosis, CNS depression, severe cardiac disorders, bone marrow disorders, drug intoxication, history of neutropenia, history of circulatory collapse, uncontrolled epilepsy

Question 3

What is the mechanism of action of clozapine?

Answer 3

Binds to several different central nervous system receptors, a strong serotonin antagonist with strong binding to 5HT 2A/2C receptors. Also has strong affinity to dopaminergic receptors but shows weak affinity to the D2 receptor - one thought to be involved in neuroleptic activity. Excessive levels of dopamine are thought to be implicated in psychosis

Question 4

What are the common side effects of clozapine?

Answer 4

Constipation, sweating, hypersalivation, urinary incontinence, speech disorders, weight gain, drowsiness, reduced seizure threshold

Question 5

What are the monitoring requirements for clozapine?

Answer 5

Monitor leucocyte and blood count - particularly white blood cells. WeightI, blood pressure, blood lipids and fasting glucose at baseline and then 3 monthly - 6 monthly for fasting glucose

Question 6

What problems are there with treatment cessation of clozapine?

Answer 6

Sweating, headache, nausea, vomiting, diarrhoea, rebound psychosis

Question 7

What patient and carer advice would you give to those on clozapine?

Answer 7

drowsiness can affect performance in driving and skilled tasks, enhances effects of alcohol, photosensitisation