Wednesday, September 28, 2016

Clozaril


Generic Name: clozapine (KLOE za peen)

Brand Names: Clozaril, FazaClo


What is clozapine?

Clozapine is an antipsychotic medication. It works by changing the actions of chemicals in the brain.


Clozapine is used to treat severe schizophrenia. Clozapine is also used to reduce the risk of suicidal behavior in people with schizophrenia or similar disorders. Clozapine is usually given after other medications have been tried without successful treatment of symptoms.


Clozapine may also be used for purposes not listed in this medication guide.


What is the most important information I should know about clozapine?


Clozapine is not for use in psychotic conditions related to dementia. Clozapine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. You should not take clozapine if you are allergic to it, or if you have untreated or uncontrolled epilepsy, a bone marrow disorder, paralytic ileus or intestinal blockage, a history of infection caused by taking clozapine, or if you are also using drugs that weaken your immune system (such as cancer medicine or steroids). Clozapine can lower blood cells that help your body fight infections. This can make it easier for you to develop a serious or life-threatening infection. This risk is higher in women and older adults, and in people who are malnourished or have serious medical problems. While you are taking clozapine, your blood will need to be tested often. Do not miss any follow-up visits to your doctor. Serious and sometimes fatal infections may occur during treatment with clozapine. Call your doctor right away if you have signs of infection such as: fever, chills, body aches, flu symptoms, mouth or throat ulcers, cough, sore throat, rapid heart rate, or rapid and shallow breathing.

There are many other medicines that can interact with clozapine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.


What should I discuss with my healthcare provider before taking clozapine?


Clozapine is not for use in psychotic conditions related to dementia. Clozapine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. You should not take clozapine if you are allergic to it, or if you have:

  • untreated or uncontrolled epilepsy;




  • a bone marrow disorder;




  • paralytic ileus or intestinal blockage;




  • a history of infection caused by taking clozapine; or




  • if you are also using drugs that weaken your immune system (such as cancer medicine or steroids).



To make sure you can safely take clozapine, tell your doctor if you have any of these other conditions:



  • heart disease, heart rhythm disorder, high blood pressure;




  • history of heart attack or stroke;




  • a personal or family history of Long QT syndrome;




  • epilepsy or other seizure disorder;




  • lung disease;




  • liver or kidney disease;




  • diabetes;




  • a history of bone marrow or blood cell disorders;




  • an enlarged prostate or urination problems;




  • glaucoma; or




  • if you smoke.




FDA pregnancy category B. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant while taking clozapine, do not stop taking it without your doctor's advice. Clozapine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are taking clozapine.

Clozapine orally-disintegrating tablets contain phenylalanine. Talk to your doctor before using this form of clozapine if you have phenylketonuria (PKU).


How should I take clozapine?


Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.


Clozapine can be taken with or without food.


Take the regular oral tablet (Clozaril) with a full glass of water.

The orally-disintegrating tablet (FazaClo) can be taken without water. Keep the tablet in its blister pack until you are ready to take it. Gently peel back the foil from the blister pack and drop the tablet onto your dry hand. Place the tablet in your mouth. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.


If your doctor has prescribed one-half of an orally-disintegrating tablet, you will need to break the tablet in half. Throw the other half away. Do not save it for later use.


Clozapine can lower blood cells that help your body fight infections. This can make it easier for you to develop a serious or life-threatening infection. This risk is higher in women and older adults, and in people who are malnourished or have serious medical problems. While you are taking clozapine, your blood will need to be tested often. Your doctor may also want to check your blood for several weeks after you stop using clozapine. Do not miss any follow-up visits to your doctor. If you stop taking clozapine for more than 2 days in a row, call your doctor before you start taking it again. If you need surgery, tell the surgeon ahead of time that you are using clozapine. Store at room temperature away from moisture and heat.

What happens if I miss a dose?


Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.


What happens if I overdose?


Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, confusion, fast heart rate, drooling, weak or shallow breathing, fainting, and seizure (convulsions).

What should I avoid while taking clozapine?


Clozapine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Avoid drinking alcohol. It can increase some of the side effects of clozapine.

Clozapine side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Serious and sometimes fatal infections may occur during treatment with clozapine. Call your doctor right away if you have signs of infection such as:

  • fever, chills, body aches, flu symptoms;




  • mouth and throat ulcers;




  • cough, sore throat;




  • rapid heart rate; or




  • rapid and shallow breathing.




Stop using clozapine and call your doctor at once if you have any of these serious side effects:

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;




  • seizure (black-out or convulsions);




  • skin rash, bruising, severe tingling, numbness, pain, muscle weakness;




  • unusual tiredness, trouble breathing;




  • feeling short of breath (even at night or with mild exertion), swelling in your hands or feet;




  • feeling like you might pass out;




  • slow heart rate, weak pulse, slow breathing (breathing may stop);




  • high blood sugar (increased thirst, extreme hunger, fruity breath odor, increased urination, drowsiness);




  • very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors;




  • twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or




  • nausea, vomiting, loss of appetite, and jaundice (yellowing of your skin or eyes).



Less serious side effects may include:



  • constipation;




  • dry mouth, blurred vision;




  • drooling, especially at night;




  • increased sweating;




  • drowsiness, dizziness, spinning sensation; or




  • sleep problems.



This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


What other drugs will affect clozapine?


Many drugs can interact with clozapine. Below is just a partial list. Tell your doctor if you are using:



  • any other antipsychotic medication;




  • armodafinil (Nuvigil) or modafinil (Progivil);




  • arsenic trioxide (Trisenox);




  • bosentan (Tracleer);




  • cimetidine (Tagamet);




  • conivaptan (Vaprisol);




  • dexamethasone (Cortastat, Dexasone, Solurex, DexPak);




  • nefazodone;




  • imatinib (Gleevec);




  • isoniazid (for treating tuberculosis);




  • phenobarbital (Solfoton) and other barbiturates;




  • St. John's wort;




  • tacrolimus (Prograf);




  • an antibiotic or antifungal medication;




  • an antidepressant;




  • anti-malaria medications;




  • atropine (Donnatal, and others), belladonna, clidinium (Quarzan), dicyclomine (Bentyl), scopolamine (Transderm-Scop);




  • heart or blood pressure medication;




  • HIV/AIDS medication;




  • medicine to prevent or treat nausea and vomiting;




  • migraine headache medicine such as sumatriptan (Imitrex, Treximet);




  • narcotic medication such as methadone (Methadose, Diskets, Dolophine); or




  • seizure medication.



This list is not complete and there are many other drugs that can interact with clozapine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.



More Clozaril resources


  • Clozaril Side Effects (in more detail)
  • Clozaril Use in Pregnancy & Breastfeeding
  • Drug Images
  • Clozaril Drug Interactions
  • Clozaril Support Group
  • 5 Reviews for Clozaril - Add your own review/rating


  • Clozaril Prescribing Information (FDA)

  • Clozaril Consumer Overview

  • Clozaril Advanced Consumer (Micromedex) - Includes Dosage Information

  • Clozaril MedFacts Consumer Leaflet (Wolters Kluwer)

  • Clozapine Prescribing Information (FDA)

  • Clozapine Professional Patient Advice (Wolters Kluwer)

  • Clozapine Monograph (AHFS DI)

  • FazaClo Orally Disintegrating Tablets MedFacts Consumer Leaflet (Wolters Kluwer)

  • FazaClo Prescribing Information (FDA)

  • Fazaclo Consumer Overview



Compare Clozaril with other medications


  • Borderline Personality Disorder
  • Paranoid Disorder
  • Schizophrenia


Where can I get more information?


  • Your pharmacist can provide more information about clozapine.

See also: Clozaril side effects (in more detail)


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