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Clozaril (Clozapine) is an atypical antipsychotic drug that is primarily used to treat schizophrenia in patients who do not effectively respond to other antipsychotic medications. It is also sometimes used off-label to treat other mental health conditions such as schizoaffective disorder, psychosis related to Parkinson's disease, and treatment-resistant depression.
Clozaril works differently than traditional antipsychotics. It affects multiple neurotransmitters in the brain, including serotonin, dopamine, glutamate, and histamine. The exact way Clozaril works is still not fully understood, but it is believed to reduce psychotic symptoms by affecting these neurotransmitter pathways.
Some of the benefits of using Clozaril compared to other antipsychotics include:
•Low risk of tardive dyskinesia (abnormal involuntary movements) compared to typical antipsychotics •No significant increase in prolactin levels, unlike risperidone and other atypicals •May be more effective for treatment-resistant schizophrenia •Available in oral tablet or suspension form
However, Clozaril is not without risks and side effects. The most concerning potential side effect is agranulocytosis - a severe decrease in white blood cell count. This occurs in less than 1% of patients but can be life-threatening. Patients taking Clozaril must have regular blood tests to monitor white blood cell counts.
Other common side effects of Clozaril include drowsiness, dizziness, headache, fatigue, increased salivation, weight gain, and gastrointestinal issues. Serious but rare side effects may include seizures, low blood pressure upon standing, and inflammation of the heart muscle (myocarditis) or the lining around the heart (pericarditis).
Clozaril is available in 25 mg and 100 mg oral tablets. The typical Maintenance dose to control symptoms of schizophrenia is 300-900 mg per day taken in divided doses. Therapy is usually started at 25 mg once or twice daily and gradually increased every 2-3 days until a therapeutic dose is reached. Doses above 900 mg daily are not recommended.
In conclusion, while not a first-line treatment due to the risk of agranulocytosis, Clozaril (clozapine) remains an important option for treatment-resistant schizophrenia that has not responded to other antipsychotics. Careful monitoring and a gradual dosing schedule can help minimize the risk of side effects. Clozaril has a unique mechanism of action compared to other atypicals and may offer a treatment option for select patients who have not adequately responded to other medications.
Here is a table summarizing some key information about Clozaril:
| Category | Info |
|---|---|
| Generic name | Clozapine |
| Brand names | Clozaril, Clopine, Fazaclo, Versacloz |
| Classification | Atypical antipsychotic |
| Uses | Treatment-resistant schizophrenia |
| Dosage forms | Oral tablets (25 mg, 100 mg) and oral suspension |
| Dosing | 25-900 mg/day in divided doses, titrate gradually |
| Side effects | Most common: drowsiness, dizziness, salivation, weight gain. Serious (rare): agranulocytosis, myocarditis, pericarditis |
| Monitoring | Regular white blood cell count tests |
| Pregnancy | Category B, little human data. Use only when benefits outweigh risks. |
| Breastfeeding | Excreted in breast milk. Potential risk to infant. |
| Interactions | CYP450 1A2, 2D6, and 3A4 inhibitors increase levels. Avoid alcohol and other CNS depressants. |