Mindanao Sanitarium and Hospital College Department of Nursing DRUG STUDY Generic Name/ Trade Name Clozapine Dopaminergi

c blocker Classification Indication Mechanism of Action Adverse Reactions Drug Interaction Route !re"uenc# / Dosage Adults 0 /nitial therapy * &6.4 mg 27 once or twice daily. /f using orally disinte grating tablets" begin with one half (&6.4m g of a 64mg tablet and destroy the remaini ng half. Nursing Consideration 8 !lack bo( warning. 9se only when unresponsiv e to conventiona l antipsychoti c drugs$ risk of serious C+ and respiratory effects. 7btain clozapine through the clozaril patient assistance program. Dispense only & week supply at a time. Monitor

Antipsychotic

Management of severely ill schizophreni cs who are unresponsive to standard ntipsychotic drugs. Reduction of the risk of recurrent suicidal behavior in patients with schizophreni a or schizoaffecti ve disorder (not orally disintegratin g tablet

Mechanism not fully understood. !locks dopamine receptors in the brain" depresses the RA#$ antcholinergic" antihistaminic (%& " and alpha' adrenergic blocking activitymay contribute to some of its therapeutic (and adverse and actions. Clozapine produces fewer e(trapyramidal effects than other antipsychotics.

C)#* Drowsiness" sedation seizures" dizziness" syncope" headache" tremor" disturbed sleep" nightmares" restlessness" agitation" increase salivation" sweating" tardive dyskinesia" neuroleptic malignant syndrome C+* ,achycardia" hypotension"hyp ertension" -C. changes" potentially fatal myocarditis ./* )ausea" +omiting"

Drug'drug 0 /ncreased therapeutic and to(ic effects with cimetidine" caffeine" other C12345 inhibitors 0 Decreased therapeutic effects with phenytoin" ethotoin" other C12345 inducers

constipation" abnormal discomfort" dry mouth .9* 9rinary abnormalities %ematologic* :eukopenia" agranuloytosis 7ther* fever" weight gain" rash" development of diabetes mellitus

Continu e to 64 mg 27 daily increm ents of 64'45 mg;day " if tolerat ed" to a dose of <55' 345 mg;day by the end of second week. Ad=ust later dosage no more often than twice weekly in increm ents of less than &55 mg. do not

>!C carefully prior to first dose. 8 !lack bo( warning. >eekly monitoring of >!C during treatment and for 3 week thereafter. Dosage must be ad=usted based on >!C count. 2otentially fatal agranulocyt osis has been reported. Monitor temperature . /f fever occurs" rule out underlying infection" and consult physician for comfort measures.

e(ceed ?55 mg;day . 0 Mainte nance* Maintai n at the lowest effectiv e dose for remissi on of sympto ms. 0 Discont inuatio n of therapy * .radua l reducti on over a 6' week period is preferr ed. /f abrupt / disconti

8 !lack bo( warning. Monitor for seizures" risk increases as dose increases. Monitor elderly patients for dehydration. /nstitute remedial measures promptly$ sedation and decreased thirst related to C)# effects can lead to dehydration. Monitor patient regularly for signs and symptoms of diabetes mellitus. -ncourage voiding before taking drug to decrease

nuation is re@uire d"" carefull y monitor patient s for signs of acute psycho tic sympto ms. 0 Reinitia tion of treatm ent* Aollow initial dosage guideli nes" use e(trem e care" increas ed risk of severe advers e effects with re'

anticholiner gic effects of urinary retention. Aollow guidelines for discontinuat ion or re' institution of the drug. -ncourage patient on seriousness of potential agranulocyt osis.

e(posu re.

Reference$

%&&' (ipicott)s Nursin Drug Guide