CLOZAPINE and Refractory Schizophrenia Flashcards
Positive symptoms (over-active functioning)
- hallucinations
- delusions
- disorganised thinking, speech, behaviour
Negative symptoms
Loss of functioning
Lack of motivation
Poor self care
Blunted emotions
Reduced speech
Social withdrawal
Indicated use of CLOZAPINE
primary and others
Primary: TRS (REFRACTORY)
OTHERS:
Persistent suicidal ideation
Severe EPSE
Aggressive behaviour
Severe substance abuse
Intolerance to other antipsychotics
When should clozapine be offered?
After trial of 2 other antipsychotics
Most effect agents for CLOZAPINE AUGMENTATION
Apiprazole
Fluoxetine
Sodium valproate
Side effects of CLOZAPINE
- Neutropenia, agranulocytosis
- Myocarditis
- Cardiomyopathy
- Regular ECG and CK/ TROPONIN monitoring
Managing Clozapine side effects =
SEDATION
Give small dose in morning
Or
Reduce dose
Managing Clozapine side effects =
HYPERSALIVATION
Give HYOSCINE (KWELLS)
no anticholinergics = worsen constipation and cognition
Managing Clozapine side effects =
TACHYCARDIA
If persistent at rest, with associated fever, chest pain
May indicate MYOCARDITIS
STOP DRUG
Managing Clozapine side effects =
FEVER
Give panadol and check FBC for neutropenia
Managing Clozapine side effects =
NAUSEA
Give anti emetic
AVOID METOCLOPRAMIDE and PROCHLOPERZINE
Managing Clozapine side effects =
Gastrointestinal hypomotility (80%!!)
Proactive laxatives (softeners, stimulants, osmotic)
Clozapine community protocol:
Max days of medications supplied?
28 days on the basis of one GREEN blood result and collection of blood is within 48 hours
Missed dose=
2-3 days
Contact prescriber, retitrate from 12.5mg.
No extra monitoring
Missed dose
More than 3 days
Contact prescriber
Weekly monitoring for 6 weeks required
