Clozapine

Question 1

What is Clozapine?

Answer 1

• First atypical antipsychotic used
• D2 antagonist
• 5HT-2 antagonist
• Extremely Efficacious

Question 2

When should you use Clozapine?

Answer 2

• After two antipsychotics have not been effective

Question 3

What are some of the risks with Clozapine?

Answer 3

• Agranulocytosis (severe leukopenia - especially neutrophils)
• GI hypo-mobility (fatal bowel obstruction - toxic megacolon)
• Hypersalivation
• Urinary Incontinence

Question 4

How do you monitor Clozapine?

Answer 4

• Monitor FBC (weekly for 18 weeks, every 2 weeks for up to a year, monthly)

Question 5

How do you treat Agranulocytosis?

Answer 5

• Stop Clozapine
• Stop any marrow suppressing drugs
• Avoid Antipsychotics for a couple of weeks
• Contact Consultant Haematologist
• Broad Spectrum Abx
• Lithium used to increase WCC and Neutrophils
• G-CSF is used