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Until further studies have been conducted, we suggest that patients who are treatment refractory and stabilised on Clozaril are not switched to a generic formulation. On the other hand, if a patient is stabilised on Clozaril and not treatment refractory, then cautious switching to a generic formulation may be reasonable.
The cost implications related to these recommendations will depend on the success or failure of treatment. But I have seen some patients, though it's rare, be able to tolerate one med but not another that are supposed to be the same med, but one is generic and the other is not.
It's not common, but I tend to get at least one person every few months if not more where this happens. The person can tolerate Citalopram but not Lexapro, or the person can tolerate Citalopram from Walgreens but not from CVS. How can this be. Medications usually aren't the pure medication in and of itself. Take Prozac flouxetine for example.
CLOZARIL can cause neutropenia a low absolute neutrophil count ANCdefined as a reduction below pre-treatment normal levels of blood neutrophils. The ANC is usually available as a component of the complete blood count CBCincluding differential, and is more relevant to drug-induced neutropenia than is the white blood cell WBC count.
Neutropenia may be mild, moderate, or severe see Tables 2 and 3. Risk of neutropenia appears greatest during the first 18 weeks on treatment and then declines. The mechanism by which CLOZARIL causes neutropenia is unknown and is not dose-dependent. Two separate management algorithms are provided below, the first for patients in the general population, and the second for patients identified to have baseline neutropenia.
Weekly ANC monitoring is required for all patients during the first 6 months of treatment. BEN is more common in men. Patients with BEN have normal hematopoietic stem-cell number and myeloid maturation, are healthy, and do not suffer from repeated or severe infections. They are not at increased risk for developing CLOZARIL-induced neutropenia. Additional evaluation may be needed to determine if baseline neutropenia is due to BEN. Consider hematology consultation before initiating or during CLOZARIL treatment as necessary.
Patients with BEN require a different ANC algorithm for CLOZARIL management due to their lower baseline ANC levels. Table 3 provides guidelines for managing CLOZARIL treatment and ANC monitoring in patients with BEN. A hematology consultation may be useful in deciding to rechallenge a patient.
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A preliminary report of the pertinent bioavailability results is presented here. Such intraindividual differences raise the issue of average bioequivalence versus individual bioequivalence and the implication for interchangeability of different clozapine formulations.
The decision to switch a patient from branded to generic clozapine should be made on an individual basis with special emphasis on clinical outcome, and patients should be monitored closely during the transition. Tse G, Thompson D, Procyshyn RM. Source Department of Pharmacy, Riverview Hospital, Port Coquitlam, British Columbia, Canada. Abstract As a consequence of its prevalence, early onset and chronicity, schizophrenia imposes clinical and economic impediments to healthcare practitioners and society alike.
Among the many antipsychotics available to treat the symptoms of this devastating illness, clozapine has emerged and differentiated itself from the others as the agent most efficacious for the treatment of refractory patients.
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Clozapine is a substrate for many cytochrome P450 isozymes, in particular CYP1A2, CYP3A4, and CYP2D6. Use caution when administering CLOZARIL concomitantly with drugs that are inducers or inhibitors of these enzymes. Concomitant use of CLOZARIL and CYP1A2 inhibitors can increase plasma levels of clozapine, potentially resulting in adverse reactions.
Reduce the CLOZARIL dose to one third of the original dose when CLOZARIL is coadministered with strong CYP1A2 inhibitors e. Moderate or weak CYP1A2 inhibitors include oral contraceptives and caffeine. Monitor patients closely when CLOZARIL is coadministered with these inhibitors.
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The increased risk of myocarditis is greatest in the first 2 months of treatment. Fatal cases of cardiomyopathy have also been reported rarely see section 4. If myocarditis or cardiomyopathy are suspected, Clozaril treatment should be promptly stopped and the patient immediately referred to a cardiologist see section 4.
Patients who develop clozapine-induced myocarditis or cardiomyopathy should not be re-exposed to clozapine see section 4. Clozapine-induced agranulocytosis: a genetic and epidemiologic study. Yellow, circular, flat tablet with bevelled edges. Clozaril is indicated in treatment-resistant schizophrenic patients and in schizophrenia patients who have severe, untreatable neurological adverse reactions to other antipsychotic agents, including atypical antipsychotics.
Common Buy Colofac ide effects may include:
The risk is highest during the initial titration period, particularly with rapid dose escalation.
Clozapine may lower your blood pressure.
It is unclear if concurrent use of other drugs known to cause neutropenia increases the risk or severity of CLOZARIL-induced neutropenia.
Thus, CLOZARIL may be administered with or without food.
If you become pregnant while taking Clozaril, do not stop taking it without your doctor's advice. Clozapine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are taking Clozaril. Take Clozaril exactly as prescribed by your doctor. Follow all directions on your prescription label.
Where can I get more information?
It is this monitoring requirement which serves as the basis for the Clozapine risk evaluation and mitigation strategy REMS.
What other drugs will affect clozapine Clozaril, FazaClo.