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Clozapine - Coggle Diagram
Clozapine
Side-Effects
Anticholinergic
Dry mouth
Dry eyes
Urinary retention
Hypotensive symptoms
Drowsiness
Metabolic syndrome
Hypersalivation
Less likely than other APs
EPSEs
Hyperprolactinaema
Monitoring
Initiation
Pregnancy/contraception
Physical exam
Weight
Obs
ECG
Review PMH and meds
FBC
Falls risk
Baseline bowel habits
Ongoing
Regular FBC
18wks - weekly
18wks-1yr - fortnightly
1yr+ - 4wkly
Green
WBC >3.5
Neuts >2
Give clozapine
Amber
WBC 3-3.5
Neuts 1.5-2
Twice wkly FBC until green
Red
Neuts <1.5
Stop clozapine
WBC <3
Less regular
Troponin and CRP
ECGs
Yearly review of weight, obs etc
Monitoring service
Clozaril/Denzapine
"Release" meds
Register patient
Levels
Optimal 0.35-0.6
Physically unwell/seizures
Smoking
Not routine
Advice
Seek help if evidence of infection
Smoking
Smoking decreases clozapine levels
Stop taking for 48hrs
Retitrate
Pregnancy
No known issues for baby in womb
Neonatal withdrawal on birth - hospital delivery
No problems for men
Type of drug
Class
Second generation antipsychotic
Mechanism
Blocks neurotransmitter receptors
Serotonin type 2
Norepinephrine
Histamine
Dopamine type 4
Acetylcholine
Indication
Treatment-resistant schizophrenia
Tried 2 APs, at least one of which is second generation
Efficacy
80% respond
Psychosis in Parkinson's Disease
Rarely used
Adverse Effects
Clozapine-Specific
Agranulocytosis
Constipation
Severe - fatality 20-30%
Myocarditis
Neutropenia
Generic
Prolonged QTc
Lowers seizure threshold
NMS