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Factsheets

Initiating treatment

The Summary of Product Characteristics (SmPC) for Clozaril® (clozapine) includes the following information regarding initiation of treatment with clozapine: For treatment-resistant schizophrenic patients, start therapy with 12.5mg once or twice on the first day, followed by 25mg once or twice on the second day.

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Benign ethnic neutropenia

Benign ethnic neutropenia (BEN) can be defined as: ‘The occurrence of neutropenia, defined by normative data in white populations, in individuals of other ethnic groups who are otherwise healthy and who do not have repeated or severe infections’.

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Eosinophilia

Eosinophilia is a common (≥1/100 but <1/10) side-effect of Clozaril® (clozapine).

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Gastrointestinal side-effects

This information sheet will cover the following side-effects: nausea, vomiting, dysphagia, dry mouth and parotid gland enlargement.

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General anaesthesia

If a patient on Clozaril® (clozapine) is going to have surgery it is essential that the anaesthetist is aware that the patient is taking clozapine so that the anaesthetic protocol can be reviewed as necessary.

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Hypersalivation

The Summary of Product Characteristics of Clozaril® (Clozapine) states that hypersalivation is a very common (≥1/10) side effect.

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Red alert management

The most well recognised side-effects of clozapine are neutropenia, defined as a neutrophil count of less than 1.5 x 109/L and agranulocytosis which is a neutrophil count of less than 0.5 x 109/L.

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Weight gain

The Summary of Product Characteristics (SmPC) for Clozaril® (clozapine) states that: Weight gain has been observed with atypical antipsychotic use, including Clozaril®.

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Discontinuing treatment

The Summary of Product Characteristics (SmPC) for Clozaril® (clozapine) states: In the event of planned termination of Clozaril® therapy, a gradual reduction in dose over a 1 to 2-week period is recommended.

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​​Clozapine Constipation

The Summary of Product Characteristics (SPC) for Clozaril® (clozapine) lists constipation as a very common (>1/10) reaction to Clozaril®.

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Use of clozapine in patients aged 60 years and older

Clozapine has been shown to be effective in treating elderly patients with schizophrenia.

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Clozapine and compliance

Compliance may be defined as the extent to which a person's behaviour coincides with the medical advice he/she has

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Clozapine therapy: role of therapeutic drug monitoring (TDM)

Although antipsychotic efficacy with Clozaril® (clozapine) can be expected with doses of 200 to 450 mg/day, the approved dose range extends up to 900mg/day

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Clozapine and seizures

Clozapine lowers the seizure threshold in a dose-dependent manner and may induce myoclonic jerks or generalised seizures

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Clozapine and fever

During Clozaril® therapy, patients may experience transient temperature elevations above 38°C, with the peak incidence within the first 3 weeks of treatment

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Clozapine and neuroleptic malignant syndrome

NMS is a serious and potentially fatal symptom complex that has been reported in association with antipsychotic drugs.

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Clozapine and cardiovascular events

Tachycardia typically occurs in the first few weeks of treatment and it may persist in some patients. It is usually dose-related.

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Clozapine and urinary incontinence/urinary retention

Urinary incontinence and urinary retention are common (≥1/100 but <1/10) side-effects of Clozaril®. Nocturnal enuresis is also listed as an adverse effect which has a frequency of 'not known'.

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Clozapine and liver function

The Summary of Product Characteristics (SmPC) for Clozaril® (clozapine) states that: elevation of liver enzymes is a common (≥1/100 but <1/10) reaction to Clozaril®,

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Clozapine, diabetes and hyperglycaemia

The Summary of Product Characteristics (SmPC) for Clozaril® (clozapine) states that diabetes mellitus and impaired glucose tolerance are rare (≥1/10,000 but <1/1,000) side effect.

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Clozapine Overdose

In cases of acute intentional or accidental Clozaril® overdose for which information on the outcome is available, mortality to date is about 12%.

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Materials

What to expect from Clozaril®

This booklet is intended only for patients who have been prescribed Clozaril® and/or their family/carers.

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Clozaril® leavepiece

NICE defines ‘treatment resistance’ in schizophrenia patients as the lack of satisfactory clinical improvement following sequential treatment with at least two different antipsychotic drugs, including at least one second-generation (atypical) antipsychotic.

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