clozapine

Question 1

what type of drug is clozapine?

Answer 1

2nd generation antipsychotic

Question 2

what is the MOA for clozapine?

Answer 2

5-HT antagonist, strong binding to 5-HT 2A/2C receptor subtype. Strong affinity to dopamingeric receptors but weak antagonism to D2 receptor (which is thought to have a positive influence on mood, emotion and sleep). Increased levels of dopamine is implicated in psychotic symptoms.

Question 3

what are the contraindications for clozapine?

Answer 3

alcohol and toxic psychoses, coma, bone marrow diseases, history of agranulocytosis/ neutropenia, uncontrolled epilpesy, severe cardiac disorders, CNS depression.

Question 4

common side effects?

Answer 4

drooling, insomnia, sweating, weight gain, dry mouth, blurred vision, decreases seizure threshold and constipation.

Question 5

monitoring requirements for clozapine?

Answer 5

leukocytes and blood count must be normal before starting, every week for 18 weeks, then every 2 weeks, if stable levels for a year then every 4 weeks. If neutrophil count is below 1500mm3 then stop, If leukocyte count below 3000mm3 then stop. Blood lipids and weight at baseline, 1 month then 4-6 months/

Question 6

treatment cessation for clozapine?

Answer 6

planned withdrawal, 1-2 weeks= avoid rebound psychosis. increased risk of relapse if stopped after 1-2 years.

Question 7

patient/ carer advice for clozapine?

Answer 7

photosensitisation & drowsiness many affect skilled tasks, alcohol enhances, administration advice on oral suspension