clozapine
| Uses: | treatment resistant schizophrenia - specialist only |
|---|---|
| Mechanism of action | |
| Dose | |
| Pharmacokinetics | Absorption PO Distribution Metabolism CYP1A2, CYP3A4, with weakly active metabolites Elimination 50% urine |
| Time course of action | |
| Adverse effects | Anticholinergic effects - Orthostatic hypotension, seizures, tachycardias |
| Contraindications | Constipation - can cause fatal ileus |
important side effects
practicalities
monitoring
- each brand in the UK has their own monitoring service
- monitoring of levels recommended with:
- serious infection
- nicotine replacement therapy
- interactions suspected
- done with a 10-14h trough sample
- normal range 0.35-0.42 (...ish?)
stopping and starting
dose needs to be titrated
if stopped >48h, need to re-titrate
sources/links
https://sps.nhs.uk/articles/clinical-considerations-for-patients-prescribed-clozapine/
https://www.gov.uk/drug-safety-update/clozapine-and-other-antipsychotics-monitoring-blood-concentrations-for-toxicity
https://www.rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/mental-health/clozapine-initiation-and-re-titration-specialist-mental-health-guidelines/