The risk of TD and the likelihood that it will become irreversible are believed to increase with greater durations of treatment and higher total cumulative doses. Correct electrolyte abnormalities. Caution with drugs that affect or are affected by CYP2D6, 3A4, 1A2; clozapine levels increased by CYP450 inhibitors (eg, bupropion, cimetidine, erythromycin); clozapine levels decreased by CYP450 inducers (eg, rifampin, phenytoin, St. John's wort). Additional evaluation may be needed to determine if baseline neutropenia is due to BEN. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Caution when rechallenging.

Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality in this population. Clozapine is primarily metabolized by CYP isoenzymes 1A2, 2D6, and 3A4. The structural formula is: Clozaril is available in pale yellow tablets of 25 mg, 50 mg, 100 mg and 200 mg for oral administration. Seizures. While this fever is generally benign and self-limited, it may necessitate discontinuing treatment. Advise patients to immediately report symptoms consistent with severe neutropenia or infection (e.g., fever, weakness, lethargy, or sore throat)Because of the risk of severe neutropenia, Clozaril is available only through a restricted program under a Risk Evaluation Mitigation Strategy (REMS) called the Clozapine REMS Program Orthostatic hypotension, bradycardia, syncope, and cardiac arrest have occurred with Clozaril treatment. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. The baseline ANC must be at least 1500/µL for the general population, and at least 1000/µL for patients with documented Benign Ethnic Neutropenia (BEN). Subjective symptoms of constipation may not accurately reflect the degree of gastrointestinal hypomotility in Clozaril Eosinophilia, defined as a blood eosinophil count of greater than 700/µL, has occurred with Clozaril treatment.

Edit. Because of the risks of severe neutropenia and of seizure associated with its use, Clozaril should be used only in patients who have failed to respond adequately to standard antipsychotic treatment The effectiveness of Clozaril in treatment-resistant schizophrenia was demonstrated in a 6-week, randomized, double-blind, active-controlled study comparing Clozaril and chlorpromazine in patients who had failed other antipsychotics Clozaril is indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for re-experiencing suicidal behavior, based on history and recent clinical state. Clozapine concentrations may be increased in these patients, because clozapine is almost completely metabolized and then excreted Dose reduction may be necessary in patients who are CYP2D6 poor metabolizers. The antipsychotic trials must have been judged adequate; the antipsychotic dosages must have been equivalent to or greater than 1000 mg per day of chlorpromazine for a period of at least 6 weeks, each without significant reduction of symptoms.

Add your location. This result should be interpreted only as evidence of the effectiveness of Clozaril in delaying time to recurrent suicidal behavior and not a demonstration of the superior efficacy of Clozaril over olanzapine.The probability of experiencing (1) a significant suicide attempt, including a completed suicide, or (2) hospitalization because of imminent suicide risk, including increased level of surveillance for suicidality for patients already hospitalized, was lower for Clozaril patients than for olanzapine patients at Week 104: Clozaril 24% versus olanzapine 32%; 95% CI of the difference: 2%, 14% (Discuss the following issues with patients and caregivers:The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. There must have been no period of good functioning within the preceding 5 years.