Clozapine

Question 1

Indication

Answer 1

Refractory schizophrenia

Question 2

Inclusion criteria for clozapine

Answer 2

Trialled 2 other antipsychotics one of ehich being an atypical antipsychotic
Tardive dyskinesia
Experience unacceptable side effects

Question 3

Which factors makes a patient un eligible for clozapine

Answer 3

Hypersensitivity 
Unavle yo do regular blood tests
Impaired bone marrow 
Uncontrolled epilepsy 
Alcoholic and other toxic psychoses
Drug intoxicification
Paralytic ileus

Question 4

What is the required monitoring for clozapine and timings

Answer 4

FBC, bp and pulse, weight and height, random glucose should be monitored for first 18 weeks then fortnightly for up to the year then monthly
Need to also measure for seizures and constipation
Crp/ troponin weekly for first 4 weeks
Pre and post clozapine bp 2 hours each side
Ecg and temp whilst titrating daily

Question 5

Side effects associated with clozapine

Answer 5

Tachycardia 
Weight gain
Diabetes
Prolacteraemia
Agranulocytosis 
Hypersalivation
Dizziness 
Sedation 
Nausea/vomiting
Dry mouth
Urinary problems
Pneumonia 
Myocarditis
Orthostatic hypertension 
Myocarditis
Pyrexia
Thromboembolism

Question 6

Standard dose for clozapine

Answer 6

12.5mg titrated up to 200mg -450mg daily

Max 900mg

Question 7

How is hypersalavation treated associated with clozapine

Answer 7

Hyoscine hydrobromide
Atropine eye drops orally
Trihexypheidyl

Question 8

What is the trough level for clozapine and when should it be carried out

Answer 8

0.35-0.6mg/L

12 hours after the evening dose

Question 9

What sre the circumstances in which you have to retitrate the dose of clozapine

Answer 9

Smoking

Cessation of treatment