DRUG MECHANISM OF
ACTION
CLOZAPINE
PHARMACOTHERAPEUTIC:
Dibenzodiazepine derivative.
CLINICAL: Antipsychotic.
100 mg 1 tab BID (twice a day)
INDICATION CONTRAINDICATION ADVERSE EFFECTS
Interferes with binding of Management of severely ill Contraindications: History of
dopamine and serotonin schizophrenic pts who have clozapineinduced
receptor sites. Therapeutic failed to respond to other agranulocytosis or severe
Effect: Diminishes antipsychotic therapy. granulocytopenia.
schizophrenic behavior. Treatment of recurrent Cautions: History of seizures,
suicidal behavior. cardiovascular disease,
OFF-LABEL: myocarditis, respiratory/
Schizoaffective disorder, hepatic/renal impairment,
bipolar disorder, childhood alcohol withdrawal, high risk
psychosis, obsessive- of suicide, paralytic ileus,
compulsive disorder, myasthenia gravis, pts at risk
agitation related to for aspiration pneumonia,
Alzheimer’s dementia. urinary retention, narrow-
angle glaucoma, prostatic
hypertrophy, xerostomia,
visual disturbances,
constipation, history of bowel
obstruction, diabetes mellitus.
History of long QT
prolongation/ ventricular
arrhythmias; concomitant use
of medications that prolong
QT interval; hypokalemia,
hypomagnesemia.
Pregnancy Category B.
NSG RESPONSILITIES
Seizures occur occasionally BASELINE ASSESSMENT
(3% of pts). Overdose Obtain baseline weight, glucose,
produces CNS depression Hgb A1c, WBC, absolute neutrophil
(sedation, delirium, coma), count (ANC) before initiating
respiratory depression, treatment. Assess behavior,
hypersalivation. Blood appearance, emotional status,
dyscrasias, particularly response to environment, speech
agranulocytosis, mild pattern, thought.
leukopenia, may occur.
INTERVENTION/EVALUATION
Monitor B/P for
hypertension/hypotension.
Assess pulse for tachycardia
(common side effect). Monitor CBC
for blood dyscrasias. Monitor ANC,
WBC count every wk for first 6 mos,
then biweekly for 6 mos. If CBC and
ANC are normal after 12 mos, then
monthly monitoring of CBC and
ANC is recommended. Supervise
suicidal-risk pt closely during early
therapy (as depression lessens,
energy level improves, increasing
suicide potential). Assess for
therapeutic response (interest in
surroundings, improvement in self-
care, increased ability to concentrate,
relaxed facial expression).
PATIENT/FAMILY TEACHING
Do not abruptly discontinue long-
term drug therapy. Avoid tasks that
require alertness, motor skills until
response to drug is established.
Drowsiness generally
subsides during continued therapy.
Avoid alcohol, caffeine. Report
fever, sore throat, flu-like symptoms