Clozaril

Generic Name: clozapine (KLOE za peen)
Brand names: Clozaril, FazaClo, Clopine, CloZAPine Synthon, Denzapine, Zaponex

What is Clozaril?

Clozaril (clozapine) is an antipsychotic medication. It works by changing the actions of chemicals in the brain.

Clozaril is used to treat severe schizophrenia. It is also used to reduce the risk of suicidal behavior in people with schizophrenia or similar disorders.

Clozaril is usually given after other medications have been tried without successful treatment of symptoms.

Clozaril may also be used for purposes not listed in this medication guide.

Important information about Clozaril

Clozaril is not for use in psychotic conditions related to dementia. Clozaril may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. You should not take Clozaril if you are allergic to clozapine, or if you have untreated or uncontrolled epilepsy, a bone marrow disorder, paralytic ileus or intestinal blockage, a history of infection caused by taking Clozaril, or if you are also using drugs that weaken your immune system (such as cancer medicine or steroids).

Slideshow: Grapefruit and Medicines: A Possible Deadly Mix?

Clozaril can lower blood cells that help your body fight infections. This can make it easier for you to develop a serious or life-threatening infection. This risk is higher in women and older adults, and in people who are malnourished or have serious medical problems. While you are taking Clozaril, your blood will need to be tested often. Do not miss any follow-up visits to your doctor. Serious and sometimes fatal infections may occur during treatment with Clozaril. Call your doctor right away if you have signs of infection such as: fever, chills, body aches, flu symptoms, mouth or throat ulcers, cough, sore throat, rapid heart rate, or rapid and shallow breathing.

There are many other medicines that can interact with Clozaril. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Before taking Clozaril?

Clozaril is not for use in psychotic conditions related to dementia. Clozaril may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. You should not take Clozaril if you are allergic to clozapine, or if you have:

• untreated or uncontrolled epilepsy;

• a bone marrow disorder;

• paralytic ileus or intestinal blockage;

• a history of infection caused by taking clozapine; or

• if you are also using drugs that weaken your immune system (such as cancer medicine or steroids).

To make sure you can safely take Clozaril, tell your doctor if you have any of these other conditions:

• heart disease, heart rhythm disorder, high blood pressure;

• history of heart attack or stroke;

• a personal or family history of Long QT syndrome;

• epilepsy or other seizure disorder;

• lung disease;

• liver or kidney disease;

• diabetes;

• a history of bone marrow or blood cell disorders;

• an enlarged prostate or urination problems;

• glaucoma; or

• if you smoke.

FDA pregnancy category B. Tell your doctor if you are pregnant or plan to become pregnant during treatment with Clozaril. Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. 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.

See also: Clozaril pregnancy and breastfeeding warnings (in more detail)

How should I take Clozaril?

Take Clozaril exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Clozaril can be taken with or without food.

Take the Clozaril tablet with a full glass of water.

Clozaril can lower blood cells that help your body fight infections. This can make it easier for you to develop a serious or life-threatening infection. This risk is higher in women and older adults, and in people who are malnourished or have serious medical problems. While you are taking Clozaril, your blood will need to be tested often. Your doctor may also want to check your blood for several weeks after you stop using Clozaril. Do not miss any follow-up visits to your doctor. If you stop taking Clozaril for more than 2 days in a row, call your doctor before you start taking it again. If you need surgery, tell the surgeon ahead of time that you are using Clozaril.

Store Clozaril at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, confusion, fast heart rate, drooling, weak or shallow breathing, fainting, and seizure (convulsions).

What should I avoid while taking Clozaril?

Clozaril may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Avoid drinking alcohol. It can increase some of the side effects of Clozaril.

Clozaril side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Clozaril: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Serious and sometimes fatal infections may occur during treatment with Clozaril.

Call your doctor right away if you have signs of infection such as:

• fever, chills, body aches, flu symptoms;

• mouth and throat ulcers;

• cough, sore throat;

• rapid heart rate; or

• rapid and shallow breathing.

Stop using Clozaril and call your doctor at once if you have any of these serious side effects:

• headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

• seizure (black-out or convulsions);

• skin rash, bruising, severe tingling, numbness, pain, muscle weakness;

• unusual tiredness, trouble breathing;

• feeling short of breath (even at night or with mild exertion), swelling in your hands or feet;

• feeling like you might pass out;

• slow heart rate, weak pulse, slow breathing (breathing may stop);

• high blood sugar (increased thirst, extreme hunger, fruity breath odor, increased urination, drowsiness);

• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors;

• twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or

• nausea, vomiting, loss of appetite, and jaundice (yellowing of your skin or eyes).

Less serious Clozaril side effects may include:

• constipation;

• dry mouth, blurred vision;

• drooling, especially at night;

• increased sweating;

• drowsiness, dizziness, spinning sensation; or

• sleep problems.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Clozaril side effects (in more detail)

Clozaril Dosing Information

Usual Adult Dose of Clozaril for Schizophrenia:

Treatment resistant schizophrenia:
Initial dose: 12.5 mg orally once or twice a day.
Maintenance dose: If the first dose is well- tolerated, dosages may then be titrated in daily increments of 25 mg to 50 mg for approximately two weeks until a daily dose of 300 to 450 mg is achieved. If, after the initial titration, a larger dose is necessary a slower increase in dose, not to exceed a 100 mg increment once or twice a week, may be initiated. Cautious titration and a divided dosage schedule may minimize the risks of hypotension, seizure, and sedation in the patient. However, sedation following daytime doses may necessitate administration of most or all of the daily dose at bedtime.
Maximum dose: 900 mg per day.

Reduction of the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder:
Initial dose: 12.5 mg orally once or twice a day.
Maintenance dose: If the first dose is well- tolerated, dosages may then be titrated in daily increments of 25 mg to 50 mg for approximately two weeks until a daily dose of 300 to 450 mg is achieved. If, after the initial titration, a larger dose is necessary a slower increase in dose, not to exceed a 100 mg increment once or twice a week, may be initiated. Cautious titration and a divided dosage schedule may minimize the risks of hypotension, seizure, and sedation in the patient. However, sedation following daytime doses may necessitate administration of most or all of the daily dose at bedtime.
Maximum dose: 900 mg per day.

What other drugs will affect Clozaril?

Many drugs can interact with Clozaril. Below is just a partial list. Tell your doctor if you are using:

• any other antipsychotic medication;

• armodafinil (Nuvigil) or modafinil (Progivil);

• arsenic trioxide (Trisenox);

• bosentan (Tracleer);

• cimetidine (Tagamet);

• conivaptan (Vaprisol);

• dexamethasone (Cortastat, Dexasone, Solurex, DexPak);

• nefazodone;

• imatinib (Gleevec);

• isoniazid (for treating tuberculosis);

• phenobarbital (Solfoton) and other barbiturates;

• St. John's wort;

• tacrolimus (Prograf);

• an antibiotic or antifungal medication;

• an antidepressant;

• anti-malaria medications;

• atropine (Donnatal, and others), belladonna, clidinium (Quarzan), dicyclomine (Bentyl), scopolamine (Transderm-Scop);

• heart or blood pressure medication;

• HIV/AIDS medication;

• medicine to prevent or treat nausea and vomiting;

• migraine headache medicine such as sumatriptan (Imitrex, Treximet);

• narcotic medication such as methadone (Methadose, Diskets, Dolophine); or

• seizure medication.

This list is not complete and there are many other drugs that can interact with Clozaril. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

• Your pharmacist can provide more information about Clozaril.