MRGP 2012

DRUG Clozapine (Clozaril) Therapeutic Classification: antipsychotics Pregnancy Category B

DOSAGE

MECHANISM OF ACTION

SIDE EFFECTS CNS: NEUROLEPTIC MALIGNANT SYNDROME , SEIZURES , dizziness , sedation . EENT: visual disturbances. CV: MYOCARDITIS, hypotension, tachycardia, ECG changes, hypertension. GI: constipation, abdominal discomfort, dry mouth, increased salivation, nausea, vomiting. Derm: rash, sweating. Endo: hyperglycemia. Hemat: AGRANULOCYTOSIS , LEUKOPENIA. Neuro: extrapyramidal reactions. Misc: fever, weight

MOA: Binds to dopamine PO receptors in the CNS (Adults): 25 mg 12 times daily initially; Also has anticholinergic increase by and alpha-adrenergic 2550 mg/day blocking activity over a period Produces fewer of 2 wk up to extrapyramidal target dose of reactions and less 300450 tardive dyskinesia than mg/day. May standard increase by up antipsychotics but to 100 mg/day carries high risk of once or twice hematologic further (not to abnormalities. exceed 900 Therapeutic Effects: mg/day). o Diminished schizophrenic Treatment behavior.Diminished suicidal should be behavior. continued for at least 2 yr in patients with suicidal General Indication: behavior. Schizoprenia unresponsive to or intolerant of standard Clients dose: therapy with other 100mg TID antipsychotics; To reduce recurrent suicidal behavior in schizophrenic patients.

NURSING RESPONSIBILITIES Monitor patients mental status (delusions, hallucinations, and behavior) before and periodically throughout therapy. Monitor blood pressure (sitting, standing, lying) and pulse rate before and frequently during initial dosage titration. Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded. Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects ( parkinsonian difficulty speaking or swallowing, loss of

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gain.

Contraindications: Hypersensitivity Bone marrow depression Lactation Severe CNS depression/coma.

balance control, pillrolling motion, masklike face, shuffling gait, rigidity, tremors and dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 812 wk after therapy has been discontinued. Notify physician or other health care professional if these symptoms occur. symptoms. Although not yet reported for clozapine, monitor for possible tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like

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movements of tongue). Report these symptoms immediately; may be irreversible. Monitor frequency and consistency of bowel movements. Increasing bulk and fluids in the diet may help to minimize constipation. Clozapine lowers the seizure threshold. Institute seizure precautions for patients with history of seizure disorder. Lab Test Considerations: Monitor WBC and differential count before initiation of therapy and WBC weekly for the first 6 months, then biweekly throughout therapy and weekly for 4 wk after discontinuation of clozapine. Toxicity and Overdose: Overdose is treated

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with activated charcoal and supportive therapy. Monitor patient for several days because of risk of delayed effects. o Avoid use of epinephrine and its derivatives when treating hypotension, and avoid quinidine and procainamide when treating arrhythmias.