Name of Drug Dosage, Route, Frequency
Generic Name : Adults
Clozapine
•Initial therapy:
Brand Name: 12.5 mgPO once or twice daily. If
using orally disintegrating
Clozaril,FazaClo, Gen-
tablets, begin with ½ (12.5 mg)
Clozapine (CAN)
of a 25-mg tablet and destroy
Classification: the remaining half. Continue to
25 mg PO daily or bid; then
Antipsychotic,Dopami
gradually increase with daily
nergicblocker
increments of 25–50 mg/day, if
Pregnancy Category B tolerated, to a dose of 300–450
mg/day by the end of second
week. Adjust later dosage no
more often than twice weekly in
increments <100 mg. Do not
exceed 900 mg/day.
•Maintenance:
Maintain at the lowest effective
dose for remission of symptoms.
• Discontinuation of therapy:
Gradual reduction over a 2-wk
period is preferred. If abrupt
discontinuation is required,
carefully monitor patient for
signs of acute psychotic
symptoms.
• Reinitiation of treatment:
Follow initial dosageguidelines,
use extremecare; increased risk
Mechanism of Action Indications Contraindications Adverse Reactions Nursing Responsibilities
Clozapine has relatively Management of Drowsiness, dizziness, History of bone marrow Assessment
weak dopamine severely ill headache; nausea, vomiting, disorders including
receptor-blocking schizophrenics who constipation; anxiety, agranulocytosis, •History:
activity at D1, D2, are unresponsive to confusion, fatigue, transient circulatory collapse, Allergy to clozapine,
D3and D5 standard antipsychotic fever. Rarely, dysphagia, alcoholic or toxic myeloproliferative disorders,
receptors but has high drugs acute pancreatitis, psychosis, drug history of clozapine-induced
affinity for the D4 cholestatic jaundice; intoxication, uncontrolled agranulocytosis or severe
receptor. It has also •Reduction of the risk orthostatic hypotension, epilepsy, severe renal,
granulocytopenia, severe CNS
of recurrent suicidal tachycardia; seizures; hepatic or cardiac
blocking effects on depression, comatose states,
behavior in patients hypersalivation. disease; paralytic ileus.
serotonin, α- history of seizure disorders, CV
with schizophrenia or Pregnancy and lactation
adrenergichistamine •Potentially Fatal: disease, narrow-angle glaucoma,
H1 and cholinergic schizo affective
Rarely, thromboembolism. lactation, pregnancy
disorder (not orally
receptors. Reversible neutropenia •Physical:
disintegrating tablet
which may progress to a T, weight; reflexes, orientation,
potentially fatal IOP, ophthalmologic examination;
agranulocytosis. Fatal P, BP, orthostatic BP, ECG; R,
myocarditis. adventitious sounds;
bowelsounds, normal output,
liver evaluation; prostate
palpation, normal urine output;
CBC, urinalysis, LFTs, renal
functiontests, EEG
Interventions
•BLACK BOX WARNING:
Use onlywhen unresponsive to
conventional antipsychotic drugs;
risk of serious CV and respiratory
effects.
•Dispense only 1 wk supply at a
of severe adverse effect swith
re-exposure.
Pediatric Patients
• Safety and efficacy in patients
< 16 yr not established.
time.
•Monitor WBC carefully prior to
first dose.
•BLACK BOX WARNING:
Weekly monitoring of WBC
during treatmentand for 4 wk
there after. Dosage maybe
adjusted based on WBC count.
Potentially fatal agranulocytosis
has been reported.
•Monitor T.
If fever occurs, rule out
underlying infection, and consult
physician for comfort measures.
Monitor elderly patients
for dehydration. Institute
remedialmeasures promptly;
sedation anddecreased thirst
related to CNS effectscan lead to
dehydration.
•Monitor patient regularly for
signs and symptoms of diabetes
mellitus.
•Encourage voiding before taking
drug to decrease anticholinergic
effects of urinary retention.