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Clozapine.

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VOL: 101, ISSUE: 44, PAGE NO: 31

Generic and proprietary names

- Clozapine.

- Clozaril.

- Denzapine.

- Zaponex.

Action

- Interferes with dopamine receptor binding.

Classification

- Atypical antipsychotic.

Indications

- Schizophrenia.

- Psychosis in Parkinson’s.

- Intolerance/unresponsiveness to conventional antipsychotics.

Contraindications

- Severe cardiac disorders.

- Active liver disease.

- Severe renal impairment.

- History of agranulocytosis or neutropenia.

- Bone marrow disorders.

- Paralytic ileus.

- Alcoholic and toxic psychoses.

- History of circulatory collapse.

- Drug intoxication.

- Coma or CNS depression.

- Uncontrolled epilepsy 

- Pregnancy or breastfeeding.

Cautions

- Other drugs that increase the QT interval.

- Cardiovascular disease.

- Older patients.

- Neutropenia and potentially fatal agranulocytosis.

- Avoid drugs that depress leucopoiesis.

Common side-effects

- Hypersalivation.

- Constipation, nausea, vomiting.

- Tachycardia, changes in ECG.

- Hypertension.

- Drowsiness, headache, blurred vision.

- Tremor, rigidity, convulsions.

- Extrapyramidal symptoms.

- Leucopenia, leucocytosis, agranulocytosis, eosinophilia.

- Temperature fluctuation/fever.

- Fatigue.

- Cholestatic jaundice, hepatitis, pancreatitis.

- Urinary incontinence/retention.

- Circulatory collapse, arrhythmias, myocarditis, pericarditis.

- Thromboembolism.

- Confusion, agitation, delirium.

- Restlessness.

- Diabetes mellitus.

Rare side-effects

- Intestinal obstruction.

- Dysphagia.

- Enlarged parotid gland.

- Fulminant hepatic necrosis.

- Hypercholesterolaemia, hypertriglyceridaemia.

- Thrombocytopenia, thrombocythaemia.

- Cardiac arrest, cardiomyopathy.

- Respiratory arrest.

- Interstitial nephritis.

- Priapism.

- Skin reactions.

Administration

- Tablets.

Nursing considerations

- Differential blood counts must be normal on commencement and monitored regularly.

- Due to potential for myocarditis and cardiomyopathy, patients should have:

- Full physical examination and medical history;

- Specialist examination if there are any cardiac problems; 

- Investigations for myocarditis or cardiomyopathy in the presence of tachycardia.

- Stop taking if cardiomyopathy or myocarditis is suspected.

- Use with caution in conjunction with drugs causing constipation.

- Withdraw drug over 14 days to prevent rebound psychosis.

Patient teaching

- Patients must immediately report symptoms of infection, especially flu-like symptoms.

- Avoid hot baths or showers as hypotension can occur.

- Oral hygiene is important to avoid oral candidiasis.

- Avoid overexposure to the sun as heatstroke can occur.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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