CLOZAPINE

Question 1

MHRA ALERT

Answer 1

Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus

Clozapine and other antipsychotics: monitoring blood concentrations for toxicity (August 2020)

-A patient STOPS smoking or switches to an e-cigarette;
concomitant medicines may interact to INCREASE blood clozapine levels;

-a patient has pneumonia or other serious infection;
reduced clozapine metabolism is suspected;
toxicity is suspected.

Question 2

side effects AND MONITORING

Answer 2

-avoid direct sunlight
-drowsiness
Hypersalivation- HYOSCINE HYDROBROMIDE
- QT prolongation

• Agranulocytosis
  MONITOR clozapine conc. WEEKLY FOR 18 WEEKS
  MONITOR BI-WEEKLY FOR 1 YEAR
  MONITOR MONTHLY THEREAFTER

-Myocarditis and cardiomyopathy- STOP
ECG

• constipation - TREAT

BEFORE:
Perform physical examination

AT 3 MONTHS THEN YEARLY
- Blood lipids and weight

AT 4-6 MONTHS THEN YEARLY
- Fasting blood glucose

• prolactin concentration at the start of therapy, at 6 months, and then yearly

Question 3

dosing

Answer 3

elderly dosing- at least half the adult dose and treatment reviewed regularly.