Clozapine

Question 1

When can clozapine be initiated

Answer 1

After 2 others have been tried for at least 6-8 weeks

Question 2

Is a clozapine depot available

Answer 2

No

Question 3

In 10 treatment resistance patients with schizophrenia, how many will get better with clozapine

Answer 3

6 in 10

60% improve

Question 4

4 key side effects of clozapine

Answer 4

Weight gain
Hyperprolactinemia
Constipation
Hypersalvation

Lowers seizure threshold
Agranulocytosis
Myocarditis

(stroke + VTE in elderly)

Question 5

3 key risks with clozapine

Answer 5

Lowers seizure threshold
Agranulocytosis
Myocarditis

Question 6

Baseline investigations for clozapine

Answer 6

BP
ECG
BMI

FBC, UEs, prolactin, troponin, LFTs HbA1c

Question 7

What baseline blood test may be done in clozapine initiation but not other AP

Answer 7

Troponin

Risk of myocarditis

Question 8

Clozapine monitoring schedule

Answer 8

Weekly for 18 weeks
Fortnightly till 1 year
Then monthly

Question 9

How does smoking effect clozapine

Answer 9

Smoking decreases clozapine levels

If patients wants to stop smoking, begin reiterating levels