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Fever is often the first sign of neutropenic infection. Using CLOZARIL with Other Drugs Associated with Neutropenia It is unclear if concurrent use of other drugs known to cause neutropenia increases the risk or severity of CLOZARIL-induced neutropenia. Clozapine REMS Program CLOZARIL is only available through a restricted program under a REMS called the Clozapine REMS Program because of the risk of severe neutropenia. Notable requirements of the Clozapine REMS Program include: Healthcare professionals who prescribe CLOZARIL must be certified with the program by enrolling and completing training Patients who receive CLOZARIL must be enrolled in the program and comply with the ANC testing and monitoring requirements Pharmacies dispensing CLOZARIL must be certified with the program by enrolling and completing training and must only dispense to patients who are eligible to receive CLOZARIL Further information is available at www.
Orthostatic Hypotension, Bradycardia, And Syncope Hypotension, bradycardia, syncope, and cardiac arrest have occurred with clozapine treatment. Myocarditis And Cardiomyopathy Myocarditis and cardiomyopathy have occurred with the use of CLOZARIL. Increased Mortality In Elderly Patients With Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
QT Interval Prolongation QT prolongation, Torsade de Pointes and other life-threatening ventricular arrhythmias, cardiac arrest, and sudden death have occurred with CLOZARIL treatment.
Interactions with MedicinesUsing this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases.
If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Other Medical ProblemsThe presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:Proper Use of clozapineThis section provides information on the proper use of a number of products that contain clozapine.
It may not be specific to Clozaril. Please read with care. Take this medicine exactly as directed.
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Take the tablets with or without food. Dosing The dose of this medicine will be different for different patients. Your doctor may increase your dose as needed. However, the dose is usually not more than 900 mg a day. Missed Dose If you miss a dose of this medicine, take it as soon as possible. Precautions While Using Clozaril It is important that you have your blood tests done when they are scheduled, and that your doctor check your progress at regular visits.
If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection: If you can, avoid people with infections.
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Scientists now claim that powerful drugs such as Zyprexa olanzapineClozaril clozapineand Risperdal risperidone may affect production of an enzyme known as AMPK, which influences appetite. Metabolic syndrome is a group of conditions that can increase the risk for diabetes, stroke, and heart disease. Some of the conditions include high blood pressure, insulin resistance, abnormal levels of cholesterol and triglycerides, and excess body fat around the waist.
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Such deaths have been reported very rarely in patients receiving Clozaril. Respiratory depression or arrest has occurred very rarely, with or without circulatory collapse see sections 4. If jaundice develops, Clozaril should be discontinued see section 4.
In rare cases, acute pancreatitis has been reported. Isolated cases of acute interstitial nephritis have been reported in association with Clozaril therapy. Cases of neuroleptic malignant syndrome NMS have been reported in patients receiving Clozaril either alone or in combination with lithium or other CNS-active agents.
The table below Table 4 summarises the adverse reactions accumulated from reports made spontaneously and during clinical studies. Very rare events of ventricular tachycardia and QT prolongation which may be associated with Torsades De Pointes have been observed although there is no conclusive causal relationship to the use of this medicine.
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Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
An outline of drug interactions believed to be most important with Clozaril is given in Table 2 below.
Even though it does not produce some of the disturbing side effects of other antipsychotic medications, Clozaril may cause agranulocytosis, a potentially lethal disorder of the white blood cells.
Side-effects of clozapine include lethargy, hypersalivation, constipation and somnolence.
Clozaril may lower your blood pressure, especially at the start of treatment. These symptoms can usually be prevented by getting up slowly and flexing leg muscles and toes to get the blood flowing. When getting out of bed, dangle your legs over the side for a minute or two before standing up.
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This is significant because it affects how soon withdrawal symptoms may appear.
Remember to always consult your physician or health care provider before starting, stopping, or altering a treatment or health care regimen.