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Drug Name Dosages Therapeutic Actions Indications Adverse effects Contraindications Nursing considerations
Generic Name : Adults Clozapine has relatively  Management of  Drowsiness, History of bone CLINICAL ALERT!
clozapine  Initial therapy: 12.5 mg weak dopamine severely ill dizziness, headache; marrow disorders  Name confusion has occurred between
PO once or twice daily. If receptor-blocking activity schizophrenics who nausea, vomiting, including Colazal (balsalazide); dangerous
using orally disintegrating at D1, D2, D3 and D5 are unresponsive to constipation; anxiety, agranulocytosis, effects could occur. Use caution.
Brand Name: tablets, begin with 1/2 receptors but has high standard confusion, fatigue, circulatory collapse,
Clozaril, (12.5 mg) of a 25-mg affinity for the D4 antipsychotic drugs transient fever. Rarely, alcoholic or toxic
FazaClo, Gen- receptor. It has also psychosis, drug Assessment
tablet and destroy the dysphagia, acute
Clozapine (CAN) remaining half. Continue blocking effects on pancreatitis, intoxication,  History: Allergy to clozapine,
serotonin, α-adrenergic  Reduction of the risk uncontrolled myeloproliferative disorders, history of
to 25 mg PO daily or bid; of recurrent suicidal cholestatic jaundice;
then gradually increase histamine H1 and orthostatic epilepsy, severe clozapine-induced agranulocytosis or
Classification: cholinergic receptors. behavior in patients renal, hepatic or
with daily increments of hypotension, severe granulocytopenia, severe CNS
Antipsychotic, with schizophrenia or cardiac disease;
25–50 mg/day, if tachycardia; seizures; depression, comatose states, history of
Dopaminergic schizoaffective paralytic ileus.
tolerated, to a dose of hypersalivation. seizure disorders, CV disease, narrow-
blocker disorder (not orally Pregnancy and
300–450 mg/day by the angle glaucoma, lactation, pregnancy
disintegrating tablet) lactation.
Pregnancy
end of second week.  Potentially Fatal:  Physical: T, weight; reflexes,
Adjust later dosage no Rarely, orientation, IOP, ophthalmologic
Category B more often than twice thromboembolism. examination; P, BP, orthostatic BP,
weekly in increments < Reversible ECG; R, adventitious sounds; bowel
100 mg. Do not exceed neutropenia which sounds, normal output, liver evaluation;
900 mg/day. may progress to a prostate palpation, normal urine output;
 Maintenance: Maintain at potentially fatal CBC, urinalysis, LFTs, renal function
the lowest effective dose agranulocytosis. Fatal tests, EEG
for remission of myocarditis.
symptoms. Interventions
 BLACK BOX WARNING: Use only
 Discontinuation of when unresponsive to conventional
therapy: Gradual antipsychotic drugs; risk of serious CV
reduction over a 2-wk and respiratory effects.
period is preferred. If
abrupt discontinuation is  Obtain clozapine through the Clozaril
required, carefully monitor Patient Assistance Program. For more
patient for signs of acute information, call 1-800-448-5938.
psychotic symptoms.
 Dispense only 1 wk supply at a time.
 Reinitiation of treatment:
Follow initial dosage  Monitor WBC carefully prior to first
guidelines, use extreme dose.
care; increased risk of
severe adverse effects  BLACK BOX WARNING: Weekly
with re-exposure.
monitoring of WBC during treatment
and for 4 wk thereafter. Dosage may
Pediatric Patients be adjusted based on WBC count.
 Safety and efficacy in Potentially fatal agranulocytosis has
patients < 16 yr not been reported.
established.
 Monitor T. If fever occurs, rule out
underlying infection, and consult
physician for comfort measures.

 BLACK BOX WARNING: Monitor for

seizures; with history of seizures, risk
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increases as dose increases.

 Monitor elderly patients for

dehydration. Institute remedial
measures promptly; sedation and
decreased thirst related to CNS effects
can lead to dehydration.

 Monitor patient regularly for signs and

symptoms of diabetes mellitus.

 Encourage voiding before taking drug

to decrease anticholinergic effects of
urinary retention.

 Follow guidelines for discontinuation or

reinstitution of the drug.

 Educate patient on seriousness of

potential agranulocytosis.

Teaching points
 Weekly blood tests will be taken to
determine safe dosage; dosage will be
increased gradually to achieve most
effective dose. Only 1 week of
medication can be dispensed at a time
and will depend on your white blood
cell count. Do not take more than your
prescribed dosage. Do not make up
missed doses, instead contact your
health care provider. Do not stop taking
this drug suddenly; gradual reduction of
dosage is needed to prevent side
effects.
 If you think you are pregnant or wish to
become pregnant, contact your health
care provider.

 You may experience these side effects:

Drowsiness, dizziness, sedation,
seizures (avoid driving or performing
tasks that require concentration);
dizziness, faintness on arising (change
positions slowly); increased salivation
(reversible); constipation (consult your
health care provider for correctives);
fast heart rate (rest, take your time).

 Report lethargy, weakness, fever, sore

throat, malaise, mouth ulcers, and
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flulike symptoms.

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