Clozapine: Difference between revisions
No edit summary |
ClaireLewis (talk | contribs) No edit summary |
||
(15 intermediate revisions by 7 users not shown) | |||
Line 1: | Line 1: | ||
==General== | ==General== | ||
*Type: Atypical antipsychotic | *Type: Atypical [[antipsychotic]] | ||
*Dosage Forms: | *Dosage Forms: | ||
*Common Trade Names: | **12.5, 25, 50, 100, 200 | ||
**12.5, 25, 50, 100, 150, 200 ODT | |||
*Common Trade Names: Clozaril, FezaClo, Versacloz | |||
==Adult Dosing== | ==Adult Dosing== | ||
===[[Schizophrenia]], resistant=== | |||
*150-300mg PO BID | |||
*start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days; | |||
*max 900mg/day | |||
*retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d | |||
*taper dose over 1-2 weeks to DC | |||
===Suicide prevention, schizophrenia-associated=== | |||
*150-300mg PO BID | |||
*start, increase, retitrate, and DC as above | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Schizophrenia (limited data - adjusted dose based on tolerability, clinical response) | |||
** Children >6 years PO 6.25 or 12.5mg qd | |||
** Adolescents 12.5mg 1-2x daily | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B (no evidence of risk) | ||
*Lactation: | *Lactation: possibly unsafe | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
***not defined, consider decreasing dose for significant impairment | |||
**Pediatric | **Pediatric | ||
***not available | |||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult | ||
***not defined, consider decreasing dose for significant impairment | |||
**Pediatric | **Pediatric | ||
***not available | |||
==Indications== | ==Indications== | ||
Line 26: | Line 45: | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*history of clozapine-associated myocarditis | |||
*history of agranulocytosis or granulocytopenia | |||
*uncorrected electrolyte abnormalities | |||
*caution in elderly, stroke, dementia, CAD, prolonged QT | |||
*caution if history of torsades de pointes, ventricular arrhythmias | |||
*caution if bradycardic, recent MI, CHF | |||
*caution if eosinophila | |||
*caution if pulmonary disease, hepatic impairment, seizure risk | |||
*caution if BPH, angle-closure glaucoma, DM | |||
*caution if PKU | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
Line 40: | Line 69: | ||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 4-66h | ||
*Metabolism: | *Metabolism: liver extensively | ||
*Excretion: | *Excretion: urine 50%, feces 30% | ||
*Mechanism of Action: | *Mechanism of Action: exact mechanism of action unknown, antagonizes dopamine D2, serotonin 5-HT2, α adrenergic, cholinergic muscarinic receptors, others | ||
==See Also== | ==See Also== | ||
Line 49: | Line 78: | ||
*[[Bipolar disorder]] | *[[Bipolar disorder]] | ||
*[[Borderline personality disorder]] | *[[Borderline personality disorder]] | ||
*[[ | *[[Antipsychotics]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category: | [[Category:Psychiatry]] |
Revision as of 17:46, 20 September 2019
General
- Type: Atypical antipsychotic
- Dosage Forms:
- 12.5, 25, 50, 100, 200
- 12.5, 25, 50, 100, 150, 200 ODT
- Common Trade Names: Clozaril, FezaClo, Versacloz
Adult Dosing
Schizophrenia, resistant
- 150-300mg PO BID
- start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days;
- max 900mg/day
- retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d
- taper dose over 1-2 weeks to DC
Suicide prevention, schizophrenia-associated
- 150-300mg PO BID
- start, increase, retitrate, and DC as above
Pediatric Dosing
- Schizophrenia (limited data - adjusted dose based on tolerability, clinical response)
- Children >6 years PO 6.25 or 12.5mg qd
- Adolescents 12.5mg 1-2x daily
Special Populations
- Pregnancy Rating: B (no evidence of risk)
- Lactation: possibly unsafe
- Renal Dosing
- Adult
- not defined, consider decreasing dose for significant impairment
- Pediatric
- not available
- Adult
- Hepatic Dosing
- Adult
- not defined, consider decreasing dose for significant impairment
- Pediatric
- not available
- Adult
Indications
- Controls positive and negative symptoms of psychotic disorders
- Used for schizophrenia
- Off label use:
- Bipolar disorder
- Borderline personality disorder
Contraindications
- Allergy to class/drug
- history of clozapine-associated myocarditis
- history of agranulocytosis or granulocytopenia
- uncorrected electrolyte abnormalities
- caution in elderly, stroke, dementia, CAD, prolonged QT
- caution if history of torsades de pointes, ventricular arrhythmias
- caution if bradycardic, recent MI, CHF
- caution if eosinophila
- caution if pulmonary disease, hepatic impairment, seizure risk
- caution if BPH, angle-closure glaucoma, DM
- caution if PKU
Adverse Reactions
- QT prolongation
- Myocarditis
- Agranulocytosis in 1%–2% of patients during initial treatment 3 months
- Highest ~3 months into treatment and then decreases
- Other potential side effects:
- Dyslipidemia
- Diabetes
- Decreased seizure threshold
- "Other adverse cardiovascular and respiratory effects" [1]
- "Increased mortality in elderly patients with dementia-related psychosis"[1]
Pharmacology
- Half-life: 4-66h
- Metabolism: liver extensively
- Excretion: urine 50%, feces 30%
- Mechanism of Action: exact mechanism of action unknown, antagonizes dopamine D2, serotonin 5-HT2, α adrenergic, cholinergic muscarinic receptors, others