Clozapine

The recommended dose varies widely based on need but is usually started at 12.5 mg taken once or twice daily and adjusted gradually upwards according to the doctor's instructions.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Do not stop taking Clozapine without talking to your doctor. If it becomes necessary to stop Clozapine, the dose should be reduced gradually to prevent withdrawal effects. Stopping clozapine too quickly can cause a return of the symptoms you originally started taking the medication for as well as headache, nausea, vomiting, and Diarrhea.

It is important to take Clozapine exactly as prescribed. If you miss a dose of Clozapine and remember within 2 hours, take it as soon as possible. However, if it has been more than 2 hours, skip the missed dose and go back to your regular dosing schedule. If you miss 2 or more days of clozapine doses, talk to your doctor before restarting the medication. You may need to start taking the medication at a lower dose than you were taking previously.

Store Clozapine at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may lower your white blood cell count, which can lead to fever, shivering, sore throat or infections - if you experience any of these symptoms, contact your doctor right away; it may cause constipation - to prevent this, drink plenty of water or juice, and eat more dietary fibre; it may cause drowsiness or dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause weight gain, mostly with prolonged use; it may cause excessive salivation. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

25 mg
Each pale yellow, round, bevelled-edged tablet, with "CZ25" on one side and "G/G" (pressure sensitive bisect) on the other side, contains 25 mg of clozapine. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.

50 mg
Each pale yellow, round, flat, bevelled-edged tablet, with "CZ50" on one side and "G/G" (pressure sensitive bisect) on the other side, contains 50 mg of clozapine. Nonmedicinal ingredients:colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.

100 mg
Each pale yellow, round, bevelled-edged tablet, with "CZ100" on one side and "G/G" (pressure sensitive bisect) on the other side, contains 100 mg of clozapine. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.

200 mg
Each pale yellow, oblong, normal convex tablet with "CZ200" on one side and "G/G" on the other side, contains 200 mg of clozapine. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.

Do not take Clozapine if you:

• are allergic to clozapine or any ingredients of Clozapine
• are unable to undergo regular blood tests
• have active liver disease associated with nausea, loss of appetite, or jaundice (yellowing of skin)
• have certain blood disorders (e.g., platelet disorders, low white blood cells)
• have obstruction of the bowels
• have severe heart disease (e.g., myocarditis)
• have severe Kidney Disease
• have uncontrolled Epilepsy
• have problems with drug or alcohol abuse

Do not give Clozapine to people who are in a severely sedated or comatose state.

There may be an interaction between clozapine and any of the following:

• Abiraterone
• aclidinium
• acyclovir
• alcohol
• Aldesleukin
• Aliskiren
• alpha blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• alpha agonists (e.g., Clonidine, methyldopa)
• amantadine
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, lisdexamphetamine)
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, Enalapril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
• antihistamines (e.g,. cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• anti-Parkinsons medications (e.g., amantadine, Apomorphine, levodopa, Pramipexole, Ropinirole)
• other antipsychotics (e.g., Chlorpromazine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• apomorphine
• asunaprevir
• Atomoxetine
• atropine
• azelastine
• "azole" antifungals (e.g., fluconazole, ketoconazole, Voriconazole)
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• benzodiazepines (e.g., Clonazepam, Diazepam, Lorazepam)
• Benztropine
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• Bosentan
• botulinum toxin
• brimonidine
• Bromocriptine
• Buprenorphine
• Bupropion
• Buspirone
• caffeine
• cannabis
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• chloral hydrate
• chloroquine
• Cimetidine
• Cinacalcet
• Cobicistat
• conivaptan
• Cyproterone
• Darifenacin
• Deferasirox
• Dexamethasone
• Dextromethorphan
• diabetes medications (e.g., chlorpropamide, glipizide, Glyburide, insulin, Metformin, Rosiglitazone)
• diazoxide
• Disopyramide
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• Domperidone
• Donepezil
• Dronedarone
• droperidol
• Enzalutamide
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• estrogens (e.g., ethinyl Estradiol)
• Famotidine
• Fingolimod
• Flavoxate
• Flecainide
• formoterol
• Galantamine
• Gemfibrozil
• general anaesthetics (medications used to put people to sleep before surgery)
• glucacon
• glycopyrrolate
• Guanfacine
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• hydroxychloroquine
• interferons
• ipratropium
• Leuprolide
• lithium
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• medications that can suppress the immune system (e.g., Azathioprine, biologics, cancer medications, Cyclosporine, Hydroxyurea, mycophenolate, Tacrolimus)
• Mefloquine
• Methadone
• methoxsalen
• Methylphenidate
• Metoclopramide
• Metronidazole
• Mexiletine
• mifepristone
• Minoxidil
• Mirabegron
• Mirtazapine
• Modafinil
• monoamine oxidase inhibitors (M.O.S. Moclobemide, Phenelzine, Rasagiline, Selegiline, Tranylcypromine)
• muscle relaxants (e.g., Cyclobenzaprine, methocarbamol, orphenadrine)
• Nabilone
• narcotics (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nefazodone
• nitrates (e.g., Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• Obinutuzumab
• Octreotide
• Olopatadine
• Omeprazole
• Oxybutynin
• paraldehyde
• pentamidine
• Pentoxifylline
• phenylephrine
• phosphodiesterase 5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• potassium chloride
• pramlinitide
• Primaquine
• procainamide
• Propafenone
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• rifampin
• rifabutin
• Rivastigmine
• Romidepsin
• Rufinamide
• St. John's wort
• salmeterol
• scopolamine
• serotonin antagonists (anti-emetic medications; e.g., Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• seizure medications (e.g., Carbamazepine, Clobazam, felbamate, Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine)
• Solifenacin
• sulfamethoxazole
• tacrolimus
• Tamoxifen
• Teriflunomide
• Tetrabenazine
• thalidomide
• Ticlopidine
• tiotropium
• Tizanidine
• tobacco smoke
• Tolterodine
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g.,Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• Trimethoprim
• "triptan" migraine medications (e.g., Eletriptan, Sumatriptan)
• Tryptophan
• certain tyrosine kinase inhibitors (e.g., Bosutinib, Dasatinib, imatinib, Nilotinib)
• umeclidinium
• Valacyclovir
• vilanterol
• zidovudine
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Clozapine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Clozapine.

Blood Clots: Clozapine may increase the chance of blood clot formation, causing reduction of blood flow to organs or the extremities.

If you have a history of clotting you may be at increased risk of experiencing blood clot-related problems such as heart attack, stroke, or clots in the deep veins of your leg. Discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed.

If you experience symptoms such as sharp pain and swelling in the leg, difficulty breathing, chest pain, blurred vision, or difficulty speaking, contact your doctor immediately.

Blood disorders: Because of the significant risk of serious blood disorders, including life-threatening decrease in white blood cell counts, clozapine should only be used by people for whom other medications do not work or for whom other medications cause intolerable side effects.

Blood work must be performed weekly for the first 26 weeks of treatment, then every 2 weeks for the next 26 weeks, in order to monitor the effect of the medication on the number of white blood cells. After this time, blood tests should be done at least every 4 weeks and continue for 4 weeks after the medication is stopped. If you notice lethargy (a tired and groggy feeling), weakness, fever, sore throat, flu-like complaints, or any other signs of infection, contact a doctor immediately.

For safety reasons, lab test results are recorded in patient registries. A patient registry is a database of health-related information collected from people with a particular medical condition for the purposes of safety and research. Different drug companies that make clozapine have different registries. If you switch from one brand of clozapine to another, your name will be entered into a different registry, and it will make it difficult to monitor your history of clozapine use and your safety. To ensure that this does not happen, new information will be added to the Patient Registration Form. This will help improve the way your health information is collected and shared between registries.

Diabetes: Clozapine may cause an increase in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using Clozapine.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Clozapine may affect the mental or physical abilities needed to drive or operate machinery, particularly during the first few days of taking Clozapine. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how Clozapine affects you.

Enlarged prostate: Clozapine may worsen symptoms of an enlarged prostate, such as reduced urine flow. If you have a prostate condition, discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed.

Glaucoma: People with glaucoma (increased pressure in the eyes) may find that Clozapine makes the symptoms of glaucoma worse. If you have glaucoma, discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed.

Heart and lung problems: Clozapine may increase the risk of heart and lung problems. If you have heart disease, you should not use Clozapine. Get medical attention immediately if you notice chest pain; shortness of breath; fast, irregular, or pounding heartbeat; extreme fatigue; flu-like symptoms; unexplained fever; more noticeable neck veins when standing or sitting; or fainting.

Heart rhythm: Clozapine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious, life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., if you have heart failure, Angina, or low potassium or magnesium levels), discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed.

Interruption of treatment: If you stop taking clozapine for 2 days or more, do not restart your medication at the same dosage; contact your doctor for dosage instructions.

Kidney function: Kidney disease or reduced kidney function may cause Clozapine to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed.

Liver function: Clozapine is broken down by the liver. Liver disease or reduced liver function may cause Clozapine to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Clozapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Clozapine, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Clozapine.

Clozapine may also cause a decrease in liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low Blood Pressure: Extreme lowering of blood pressure when moving from a lying or sitting to a standing position, with or without loss of consciousness, can occur with clozapine, especially at the beginning of therapy when doses are being increased. To reduce the possibility of this being problematic, rise slowly when rising from a sitting or lying position.

Movement disorder: People taking clozapine may develop tardive dyskinesia, a disorder of uncontrolled muscle movements, mainly in the face, tongue, mouth, or jaw. The risk increases with longer treatment and is higher in seniors, especially senior women. Tardive dyskinesia is more likely to be irreversible with long-term treatment (over 12 weeks). If you develop signs and symptoms of tardive dyskinesia, including sticking the tongue out, smacking the lips, pursing or puckering of lips, or other involuntary movements, contact your doctor as soon as possible.

Neuroleptic malignant syndrome: A rare but serious effect called neuroleptic malignant syndrome has been reported with antipsychotic medications such as clozapine. You should monitor for the following symptoms: altered mental status, heart palpitations, high fever, irregular pulse or blood pressure, muscle rigidity (muscle stiffness), and sweating. If you notice these symptoms, contact your doctor immediately.

Seizures: Clozapine may cause seizures. The dosing prescribed by the doctor should be carefully followed and activities requiring alertness (e.g., driving, operating machinery, swimming, climbing) should be avoided.

Pregnancy: Clozapine should be used only if the benefits clearly outweigh the risks. If you become pregnant or intend to become pregnant while taking Clozapine, contact your doctor immediately.

Breast-feeding: Clozapine may pass into breast milk. If you are a breast-feeding mother and are taking clozapine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and efficacy of Clozapine for use by children and adolescents below age 18 have not been established.

Seniors: People over the age of 60 years may have an increased risk of developing side effects from Clozapine. Studies with antipsychotic medications have shown that seniors with Dementia taking antipsychotic medications have an increased rate of death. Seniors with dementia should not take clozapine.

This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Take it regularly and continuously to maintain its beneficial effects. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. If you have stopped taking the drug for more than 2 days, contact your health care professional for dosing instructions. This medication may be taken with or without food. This product may intensify the effect of alcohol. Limit alcohol consumption to an occasional intake.