However, research has shown that long-term use (7–11 years) of any antipsychotic treatment by people with schizophrenia is associated with lower mortality than no drug use and clozapine is associated with lower mortality than other commonly used first- and second-generation antipsychotic agents.
Unlike other antipsychotics, long-term clozapine use is associated with increased odds of haematological malignancies. Long-term clozapine use has a higher effect on mortality due to lymphoma and leukaemia than due to agranulocytosis.
Permanent discontinuation of clozapine treatment is recommended for patients showing evidence of agranulocytosis, myocarditis, cardiomyopathy, or QT prolongation greater than 500 ms if no alternative causes can be found.
Clozapine can also cause problems with your metabolism. This includes high cholesterol, high blood sugar, and weight gain. This may lead to complications, like hypertension, Type 2 diabetes, and obesity. It's important to discuss ways to lower your risk for these long-term problems with your healthcare provider.
Rapid discontinuation of clozapine has been reported to cause rebound psychosis and worsening of symptoms within 24 to 48 hours of drug cessation.
Undoubtedly the most significant barrier to use of clozapine is the stringent restrictions around blood monitoring. Clozapine was first introduced in the 1970s in Europe, but was withdrawn after the drug was shown to be associated with agranulocytosis—an acute condition involving severe leukopenia.
The most common ADR cited as a reason for discontinuation from a patient decision was sedation (n = 15), followed by nausea (n = 6), hypersalivation (n = 4) and weight gain (n = 4). Adverse drug reactions (ADRs) cited as a reason for discontinuation of clozapine for 80 patients (130 ADRs).
Clozapine may cause myocarditis (swelling of the heart muscle that may be dangerous) or cardiomyopathy (enlarged or thickened heart muscle that stops the heart from pumping blood normally).
Clozapine is associated with several significant adverse effects, including agranulocytosis, neutropenia, constipation (which can be severe), myocarditis and adverse metabolic effects. These adverse effects are not necessarily dose-related and may occur at any time during treatment.
Clozapine is an antipsychotic medicine that helps to adjust the levels of dopamine and other chemicals available in your brain. Clozapine reduces dopamine activity where it is too high, helping with symptoms like hallucinations.
With a relatively short half-life of 12h and a very quick dissociation rate from the dopamine D2 receptor, pharmacokinetic and pharmacodynamics principles would dictate that clozapine be administered twice daily. However, due to clozapine's side effects (e.g., sedation), it is often prescribe once daily at bedtime.
Loxapine can be an excellent alternative to clozapine.
A very common side effect of clozapine is sedation or drowsiness. This occurs in most patients when they are new to clozapine as they titrate the dosage up. Sedation is not always a problem, since early in treatment with clozapine, people are often agitated or psychotic, and sedation can be calming.
Clozapine may cause drowsiness, blurred vision, convulsions (seizures), or to have trouble with thinking or controlling body movements, which may lead to falls, fractures or other injuries.
Clozapine intoxication can be life-threatening. Outside of the common drug–drug interactions, tobacco smoking, and caffeine consumption, infectious and inflammatory processes are important contributors to clozapine intoxication.
Results. Altogether, 24 studies reported on 1327 deaths from any causes during 217691 patient years in patients treated with clozapine. The unadjusted mortality rate in 22 unique samples during a follow-up of 1.1–12.5 (median = 5.4) years was 6.7 (95% confidence interval [CI] = 5.4–7.9) per 1000 patient years.
Doses of greater than 900 mg/day are rarely justified in women. Anyone given relatively high-dose clozapine (600 mg/day or more) should be monitored regularly for adverse events and changes in smoking habit.
These data show that clozapine can cause memory impairment and it potentiates rather than reverses hippocampal lesion-induced deficits. There are critical sex-related differences in these effects.
We demonstrated that monotherapy with second-generation oral antipsychotics performs best, especially with clozapine, followed by olanzapine and risperidone.
Clozapine differs from conventional antipsychotics for its greater efficacy in controlling positive symptoms in people with treatment-resistant illness and by inducing few extra-pyramidal effects (Kane 1988, Wahlbeck 1999).
Clozapine has unique and powerful side effects and risks, which often make it a drug of last resort.
If clozapine isn't working well after 6 months, your doctor may: Review your schizophrenia diagnosis to make sure it's correct. Check your dosage. Make sure you're taking your clozapine as prescribed.
Clozapine and olanzapine have the safest therapeutic effect, while the side effect of neutropenia must be controlled by 3 weekly blood controls.
Clozaril (clozapine) and Seroquel (quetiapine) are antipsychotic medications used to treat schizophrenia. Clozaril is also used to help reduce the risk of suicidal behavior in people with schizophrenia or similar disorders. Seroquel is also used to treat major depression and bipolar disorder.
This medication is used to treat certain mental/mood disorders (schizophrenia, schizoaffective disorders). Clozapine is a psychiatric medication (anti-psychotic type) that works by helping to restore the balance of certain natural substances (neurotransmitters) in the brain.