Clozapine

Question 1

Clozapine moa

Answer 1

Clozapine is a dopamine D1, dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic-receptor antagonist.

Question 2

Clozapine indication

Answer 2

Psychosis in Parkinson’s disease, Schizophrenia in patients unresponsive to, or intolerant of, conventional antipsychotic drugs

Question 3

Clozapine mhra

Answer 3

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

monitoring blood concentration of clozapine for toxicity in certain clinical situations such as when:

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 4

Clozapine cautions

Answer 4

Age over 60 years;prostatic hypertrophy;susceptibility to angle-closure glaucoma;taper off other antipsychotics before starting

Question 5

General antipsychotic side effects

Answer 5

Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension (dose-related); insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased,

Question 6

Clozapine monitoring

Answer 6

prolactin concentration at the start of therapy, at 6 months, and then yearly - Monitor leucocyte and differential blood counts. Clozapine requires differential white blood cell monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly as part of the clozapine patient monitoring service. Blood lipids and weight should be measured at baseline, at 3 months (weight should be measured at frequent intervals during the first 3 months), and then yearly with antipsychotics., Fasting blood glucose should be measured at baseline, at 4–6 months, and then yearly.

Question 7

Clozapine side effects

Answer 7

Appetite decreased; eosinophilia; fatigue; fever; headache; hypertension; leucocytosis; muscle complaints; nausea; oral disorders; postural hypotension (dose-related); speech impairment; sweating abnormal; syncope; temperature regulation disorders; urinary disorders; vision blurred