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Versacloz (clozapine) Disease Interactions

There are 20 disease interactions with Versacloz (clozapine):

Major

Atypical Antipsychotic Agents (Includes Versacloz) ↔ Dementia

Severe Potential Hazard, High plausibility

Applies to: Dementia

Elderly patients with dementia- related psychosis treated with antipsychotic drugs are at an increased risk of death, mostly from cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) causes. A causal relationship with antipsychotic use has not been established. In controlled trials, treatment with some atypical antipsychotic drugs was also associated with an increased risk of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in elderly patients with dementia- related psychosis. These agents are not approved for the treatment of patients with dementia- related psychosis.

Major

Clozapine (Includes Versacloz) ↔ Agranulocytosis

Severe Potential Hazard, High plausibility

Applies to: Neutropenia

The use of clozapine is contraindicated in patients with myeloproliferative disorders, preexisting bone marrow depression, or a history of clozapine-induced agranulocytosis or severe granulocytopenia. Clozapine therapy is associated with the development of agranulocytosis, defined as an absolute neutrophil count (ANC) below 500/mm3. The cumulative incidence is estimated at 1% to 2% after one year of use. The onset is generally between 4 to 16 weeks following initiation of therapy, and it is usually reversible if detected early and the drug discontinued promptly. All patients should have a white blood cell (WBC) count prior to initiating therapy, and clozapine should not be administered if baseline WBC count is less than 3500/mm3. WBC counts and differential should be monitored closely during therapy and for 4 weeks after end of therapy according to product labeling. Also, patients should be advised to immediately report signs of infection such as fever, sore throat, malaise, lethargy, and flu-like symptoms. Individuals who develop clozapine-induced agranulocytosis or severe granulocytopenia (WBC count < 2000/mm3 or ANC < 1000/mm3) should not be rechallenged following recovery, since the condition may recur, often with a shorter latency on reexposure. If continued neuroleptic therapy is necessary, other agents may be used with little apparent risk of cross-sensitivity.

References

  1. Gerson SL, Guillion G, Hong-Shen Y, Masor C "Granulocyte colony-stimulating factor for clozapine-induced agranulocytosis." Lancet 340 (1992): 1097
  2. Gerson SL "Clozapine--deciphering the risks.." N Engl J Med 329 (1993): 204-5
  3. Weide R, Koppler H, Heymanns J, Pfluger KH, Havemann K "Successful treatment of clozapine induced agranulocytosis with granulocyte-colony stimulating factor (G-CSF)." Br J Haematol 80 (1992): 557-9
  4. Gullion G, Yeh HS "Treatment of clozapine-induced agranulocytosis with recombinant granulocyte colony-stimulating factor." J Clin Psychiatry 55 (1994): 401-5
  5. Safferman AZ, Lieberman JA, Alvir JMJ, Howard A "Rechallenge in clozapine-induced agranulocytosis." Lancet 339 (1992): 1296-7
  6. Gerson SL, Arce C, Meltzer HY "N-desmethylclozapine - a clozapine metabolite that suppresses haemopoiesis." Br J Haematol 86 (1994): 555-61
  7. Hummer M, Kurz M, Barnas C, Fleischhacker WW "Transient neutropenia induced by clozapine." Psychopharmacol Bull 28 (1992): 287-90
  8. Peck CC "FDA's position on the clozaril patient management system." Hosp Community Psychiatry 41 (1990): 876-7
  9. Clozapine Study Group "The safety and efficacy of clozapine in severe treatment-resistant schizophrenia patients in the UK." Br J Psychiatry 163 (1993): 150-4
  10. Alvir JM, Lieberman JA, Safferman AZ, Schwimmer JL, Schaaf JA "Clozapine-induced agranulocytosis. Incidence and risk factors in the United States." N Engl J Med 329 (1993): 162-7
  11. Pisciotta AV, Konings SA, Ciesemier LL, Cronkite CE, Lieberman JA "Cytotoxic activity in serum of patients with clozapine-induced agranulocytosis." J Lab Clin Med 119 (1992): 254-66
  12. Amsler HA, Teerenhovi L, Barth E, Harjula K, Vuopio P "Agranulocytosis in patients treated with clozapine. A study of the Finnish epidemic." Acta Psychiatr Scand 56 (1977): 241-8
  13. Lieberman JA, Safferman AZ "Clinical profile of clozapine: adverse reactions and agranulocytosis." Psychiatr Q 63 (1992): 51-70
  14. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  15. Raison CL, Guze BH, Kissell RL "Successful treatment of clozapine-induced agranulocytosis with granulocyte colony-stimulating factor." J Clin Psychopharmacol 14 (1994): 285-6
  16. Joseph G, Nguyen V, Smith JD "HLA-B38 and clozapine-induced agranulocytosis." Ann Intern Med 116 (1992): 605
  17. Gerson SL "G-CSF and the management of clozapine-induced agranulocytosis." J Clin Psychiatry 55 (1994): 139-42
  18. Nielsen H "Recombinant human granulocyte colony-stimulating factor (rhg-csf filgrastim) treatment of clozapine-induced agranulocytosis." J Intern Med 234 (1993): 529-31
  19. Cates M, Lusk K, Wells BG, Guthrie TC "Nonleukopenic neutropenia in a patient treated with clozapine." N Engl J Med 326 (1992): 840-1
  20. Tueth M "Side effects of clozipine (Clozaril) requiring emergency treatment." Am J Emerg Med 11 (1993): 312-3
  21. Lieberman JA, Yunis J, Egea E, Canoso RT, Kane JM, Yunis EJ "HLA-B38, DR4, DQw3 and clozapine-induced agranulocytosis in Jewish patients with schizophrenia." Arch Gen Psychiatry 47 (1990): 945-8
View all 21 references
Major

Clozapine (Includes Versacloz) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low-potency agents such as chlorpromazine and thioridazine tend to exhibit greater anticholinergic effects than other agents in the class. Clozapine use has been associated with impairment of intestinal peristalsis ranging from constipation to intestinal obstruction, fecal impaction, and paralytic ileus. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.

References

  1. Marinkovic D, Timotijevic I, Babinski T, Totic S, Paunovic VR "The side-effects of clozapine: a four year follow-up study." Prog Neuropsychopharmacol Biol Psychiatry 18 (1994): 537-44
  2. Tueth M "Side effects of clozipine (Clozaril) requiring emergency treatment." Am J Emerg Med 11 (1993): 312-3
  3. Grohmann R, Ruther E, Sassim N, Schmidt LG "Adverse effects of clozapine." Psychopharmacology (Berl) 99 (1989): s101-4
  4. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  5. Cohen MAA, Alfonso CA, Mosquera M "Development of urinary retention during treatment with clozapine and meclizine." Am J Psychiatry 151 (1994): 619-20
  6. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 6 references
Major

Clozapine (Includes Versacloz) ↔ Hepatitis

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Hepatitis has been reported in association with the use of clozapine, both in patients with and without underlying liver function abnormalities. Therapy with clozapine should be administered cautiously in patients with preexisting liver disease. The drug should be discontinued if clinically significant elevations of liver function tests or symptoms of jaundice occur.

References

  1. Kellner M, Wiedemann K, Krieg JC, Berg PA "Toxic hepatitis by clozapine treatment." Am J Psychiatry 150 (1993): 985-6
  2. Grohmann R, Ruther E, Sassim N, Schmidt LG "Adverse effects of clozapine." Psychopharmacology (Berl) 99 (1989): s101-4
  3. Marinkovic D, Timotijevic I, Babinski T, Totic S, Paunovic VR "The side-effects of clozapine: a four year follow-up study." Prog Neuropsychopharmacol Biol Psychiatry 18 (1994): 537-44
  4. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 4 references
Major

Neuroleptics (Includes Versacloz) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

The use of neuroleptic agents is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of neuroleptic agents may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with neuroleptic agents should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  2. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  5. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  6. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  7. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  8. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  9. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
View all 10 references
Major

Neuroleptics (Includes Versacloz) ↔ Cns Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Respiratory Arrest

The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  4. Vetter PH, Proppe DG "Clozapine-induced coma." J Nerv Ment Dis 180 (1992): 58-9
  5. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  6. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  7. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
View all 7 references
Major

Neuroleptics (Includes Versacloz) ↔ Nms

Severe Potential Hazard, High plausibility

Applies to: Neuroleptic Malignant Syndrome

The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.

References

  1. Anderson ES, Powers PS "Neuroleptic malignant syndrome associated with clozapine use." J Clin Psychiatry 52 (1991): 102-4
  2. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  3. Campellone JV, Mccluskey LF, Greenspan D "Fatal outcome from neuroleptic malignant syndrome associated with clozapine." Neuropsychiatry Neuropsychol Behav Neurol 8 (1995): 70-3
  4. Sharma R, Trappler B, Ng YK, Leeman CP "Risperidone-induced neutroleptic malignant syndrome." Ann Pharmacother 30 (1996): 775-8
  5. Johnson V, Bruxner G "Neuroleptic malignant syndrome associated with olanzapine." Aust N Z J Psychiat 32 (1998): 884-6
  6. Tarsy D "Risperidone and neuroleptic malignant syndrome." JAMA 275 (1996): 446
  7. Margolese HC, Chouinard G "Olanzapine-induced neuroleptic malignant syndrome with mental retardation." Am J Psychiat 156 (1999): 1115-6
  8. SierraBiddle D, Herran A, DiezAja S, GonzalezMata JM, Vidal E, DiezManrique F, VazquezBarquero JL "Neuroleptic malignant syndrome and olanzapine." J Clin Psychopharmacol 20 (2000): 704-5
  9. Hermesh H, Sirota P, Eviatar J "Recurrent neuroleptic malignant syndrome due to haloperidol and amantadine." Biol Psychiatry 25 (1989): 962-5
  10. Najara JE, Enikeev ID "Risperidone and neuroleptic malignant syndrome: a case report." J Clin Psychiatry 56 (1995): 534-5
  11. Miller DD, Sharafuddin MJ, Kathol RG "A case of clozapine-induced neuroleptic malignant syndrome." J Clin Psychiatry 52 (1991): 99-101
  12. Levenson JL "Neuroleptic malignant syndrome after the initiation of olanzapine." J Clin Psychopharmacol 19 (1999): 477-8
  13. Dave M "Two cases of risperidone-induced neuroleptic malignant syndrome." Am J Psychiatry 152 (1995): 1233-4
  14. Chong LS, Abbott PM "Neuroleptic malignant syndrome secondary to loxapine." Br J Psychiatry 159 (1991): 572-3
  15. Burkhard PR, Vingerhoets FJG "Olanzapine induced neuroleptic malignant syndrome." Arch Gen Psychiat 56 (1999): 101-2
  16. Nemecek D "Atropism may precipitate neuroleptic malignant syndrome during treatment with clozapine." Am J Psychiatry 150 (1993): 1561
  17. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  18. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  19. Aisen PS, Lawlor BA "Neuroleptic malignant syndrome induced by low-dose haloperidol." Am J Psychiatry 149 (1992): 844
  20. Singer S, Richards C, Boland RJ "Two cases of risperidone-induced neuroleptic malignant syndrome." Am J Psychiatry 152 (1995): 1234
  21. Nyfort-Hansen K, Alderman CP "Possible neuroleptic malignant syndrome associated with olanzapine." Ann Pharmacother 34 (2000): 667
  22. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  24. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  25. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  26. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  27. Raitasuo V, Vataja R, Elomaa E "Risperidone-induced neuroleptic malignant syndrome in young patient." Lancet 344 (1994): 1705
  28. Padgett R, Lipman E "Use of neuroleptics after an episode of neuroleptic malignant syndrome" Can J Psychiatry 34 (1989): 323-5
  29. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  30. Kern JL, Cernek PK "Delayed risperidone-induced malignant syndrome." Ann Pharmacother 30 (1996): 300
  31. Ryken TC, Merrell AN "Haloperidol-induced neuroleptic malignant syndrome in a 67-year-old woman with parkinsonism." West J Med 151 (1989): 326-8
  32. Moltz DA, Coeytaux RR "Case report: Possible neuroleptic malignant syndrome associated with olanzapine." J Clin Psychopharmacol 18 (1998): 485-6
  33. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  34. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  35. Levitt AJ, Midha R, Craven JL "Neuroleptic malignant syndrome with intravenous haloperidol." Can J Psychiatry 35 (1990): 789
  36. Ewert AL, Kloek J, Wells B, Phelps S "Neuroleptic malignant syndrome associated with loxapine" J Clin Psychiatry 44 (1983): 37-8
  37. Webster P, Wijeratne C "Risperidone-induced neuroleptic malignant syndrome." Lancet 344 (1994): 1228-9
  38. Gleason PP, Conigliaro RL "Neuroleptic malignant syndrome with risperidone." Pharmacotherapy 17 (1997): 617-21
  39. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  40. DasGupta K, Young A "Clozapine-induced neuroleptic malignant syndrome." J Clin Psychiatry 52 (1991): 105-7
View all 40 references
Major

Neuroleptics (Includes Versacloz) ↔ Tardive Dyskinesia

Severe Potential Hazard, Low plausibility

Applies to: Tardive Dyskinesia

Neuroleptic agents may precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Both the risk of developing the syndrome and the likelihood that it will become irreversible increase with the duration and total cumulative dose of neuroleptic therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during neuroleptic therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms may become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of neuroleptic therapy may temporarily mask the symptoms of TD but could eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

References

  1. Kopala LC, Honer WG "Schizophrenia and severe tardive dyskinesia responsive to risperidone." J Clin Psychopharmacol 14 (1994): 430-1
  2. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  3. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  4. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  5. Ghelber D, Belmaker RH "Tardive dyskinesia with quetiapine." Am J Psychiat 156 (1999): 796-7
  6. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  8. Buzan RD "Risperidone-induced tardive dyskinesia." Am J Psychiatry 153 (1996): 734-5
  9. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  10. Little JT, Jankovic J "Tardive myoclonus." Mov Disord 2 (1987): 307-11
  11. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  12. Tamminga CA, Thaker GK, Moran M, Kakigi T, Gao XM "Clozapine in tardive dyskinesia - observations from human and animal model studies." J Clin Psychiatry 55 (1994): 102-6
  13. Dave M "Clozapine-related tardive dyskinesia." Biol Psychiatry 35 (1994): 886-7
  14. Branchey MH, Branchey LB, Richardson MA "Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients." Am J Psychiatry 138 (1981): 608-12
  15. Yassa R, Mohelsky HE "Tardive dyskinesia in thiothixene treatment ." J Clin Psychiatry 46 (1985): 151
  16. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  17. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  18. Bruun RD "Subtle and underrecognized side effects of neuroleptic treatment in children with Tourette's disorder." Am J Psychiatry 145 (1988): 621-4
  19. de Leon J, Moral L, Camunas C "Clozapine and jaw dyskinesia: a case report." J Clin Psychiatry 52 (1991): 494-5
  20. Meltzer HY, Luchins DJ "Effect of clozapine in severe tardive dyskinesia: a case report." J Clin Psychopharmacol 4 (1984): 286-7
  21. Pakkenberg H, Fog R "Spontaneous oral dyskinesia. Results of treatment with tetrabenazine, pimozide, or both." Arch Neurol 31 (1974): 352-3
  22. Gwinn KA, Caviness JN "Risperidone-induced tardive dyskinesia and parkinsonism." Mov Disord 12 (1997): 119-21
  23. Bransgrove LL, Kelly MW "Movement disorders in patients treated with long-acting injectable antipsychotic drugs." Am J Hosp Pharm 51 (1994): 895-9
  24. Portnoy RA "Hyperkinetic dysarthria as an early indicator of impending tardive dyskinesia." J Speech Hear Disord 44 (1979): 214-9
  25. Elliott ES, Marken PA, Ruehter VL "Clozapine-associated extrapyramidal reaction." Ann Pharmacother 34 (2000): 615-8
  26. Friedman JH "Clozapine treatment of psychosis in patients with tardive dystonia: report of three cases." Mov Disord 9 (1994): 321-4
  27. Mahmood T, Clothier EB, Bridgman R "Risperidone-induced extrapyramidal reactions." Lancet 346 (1995): 1226
  28. Herran A, Vazquez-Barquero JL "Tardive dyskinesia associated with olanzapine." Ann Intern Med 131 (1999): 72
  29. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  30. Peabody CA, Brody D, Warner MD "Tardive dyskinesia after low-dose haloperidol." Biol Psychiatry 22 (1987): 111-2
  31. Woerner MG, Sheitman BB, Lieberman JA, Kane JM "Tardive dyskinesia induced by risperidone?" Am J Psychiatry 153 (1996): 843
  32. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  33. Owens DGC "Extrapyramidal side effects and tolerability of risperidone - a review." J Clin Psychiatry 55 Suppl (1994): 29-35
  34. Riddle MA, Hardin MT, Towbin KE, et al "Tardive dyskinesia following haloperidol treatment in Tourette's syndrome." Arch Gen Psychiatry 44 (1987): 98-9
  35. Narendran R, Young CM, Pato MT "Possible risperidone-induced tardive dystonia." Ann Pharmacother 34 (2000): 1487-8
  36. Lamberti JS, Bellnier T "Clozapine and tardive dystonia." J Nerv Ment Dis 181 (1993): 137-8
  37. Small JG, Milstein V, Marhenke JD, Hall DD, Kellams JJ "Treatment outcome with clozapine in tardive dyskinesia, neuroleptic sensitivity, and treatment-resistant psychosis." J Clin Psychiatry 48 (1987): 263-7
  38. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  39. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  40. Dave M "Tardive oculogyric crises with clozapine." J Clin Psychiatry 55 (1994): 264-5
  41. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  42. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
View all 42 references
Moderate

Antipsychotic Agents (Includes Versacloz) ↔ Aspiration

Moderate Potential Hazard, Moderate plausibility

Applies to: Dysphagia

Esophageal dysmotility and aspiration have been associated with the use of antipsychotic drugs. These drugs should be administered cautiously in patients at risk for aspiration pneumonia.

Moderate

Antipsychotic/Neuroleptic Agents (Includes Versacloz) ↔ Seizure

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism, Seizures, Head Injury

Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.

Moderate

Atypical Antipsychotic Agents (Includes Versacloz) ↔ Hyperglycemia/Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Obesity

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported with the use of atypical antipsychotic agents. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents. It is recommended that patients with risk factors for diabetes mellitus starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment, and periodically thereafter. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when treatment with these agents was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.

Moderate

Atypical Antipsychotic Agents (Includes Versacloz) ↔ Hypotension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypotension, Syncope, Dehydration, Diarrhea, Vomiting, Ischemic Heart Disease, Congestive Heart Failure, History - Myocardial Infarction, Arrhythmias, Cerebrovascular Insufficiency

The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

Moderate

Atypical Antipsychotic Agents (Includes Versacloz) ↔ Lipid Alterations

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

Atypical antipsychotic drugs have been associated with undesirable alterations in lipid levels. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment.

Moderate

Atypical Antipsychotic Agents (Includes Versacloz) ↔ Weight Gain

Moderate Potential Hazard, Moderate plausibility

Applies to: Obesity

Weight gain has been observed with atypical antipsychotic use. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. When treating pediatric patients with atypical antipsychotic agents, weight gain should be monitored and assessed against that expected for normal growth. Monitor weight at baseline and frequently thereafter.

Moderate

Clozapine (Includes Versacloz) ↔ Hyperglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Abnormal Glucose Tolerance

Severe hyperglycemia, sometimes resulting in ketoacidosis, has been reported during clozapine treatment in patients with no prior history of hyperglycemia. Glucose levels normalized in most cases following discontinuation of clozapine, and a rechallenge in one patient produced a recurrence of hyperglycemia. While a causal relationship has not been established, patients with or predisposed to hyperglycemia should be monitored during clozapine therapy. Dosage adjustments in insulin or oral hypoglycemic medications may be necessary in patients with diabetes.

References

  1. Wehring H, Alexander B, Perry PJ "Diabetes mellitus associated with clozapine therapy." Pharmacotherapy 20 (2000): 844-7
  2. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
Moderate

Clozapine (Includes Versacloz) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Clozapine is extensively metabolized by the liver and subsequently excreted in the urine (50%) and feces (35%), primarily as metabolites. One of the metabolites appears to have only limited pharmacologic activity, while the others are inactive. However, the effects of possible metabolite accumulation have not been studied. The manufacturer recommends that therapy with clozapine be administered cautiously in patients with impaired renal function.

References

  1. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. Jann MW, Grimsley SR, Gray EC, Chang WH "Pharmacokinetics and pharmacodynamics of clozapine." Clin Pharmacokinet 24 (1993): 161-76
Moderate

Clozapine (Includes Versacloz) ↔ Thromboembolic Events

Moderate Potential Hazard, Moderate plausibility

Applies to: Pulmonary Embolism, Thrombotic/Thromboembolic Disorder

Thromboembolic events such as deep-vein thrombosis and pulmonary embolism have been noted during clozapine therapy. Therapy with clozapine should be administered cautiously in patients with an active or past history of thromboembolic events.

Moderate

Neuroleptics (Includes Versacloz) ↔ Hyperprolactinemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperprolactinemia, Breast Cancer

The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels due to antagonism of dopamine D2 receptors. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer. Caution is also advised in patients with preexisting hyperprolactinemia. Hyperprolactinemia may suppress hypothalamic gonadotrophin releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds; however, the clinical significance of elevated serum prolactin levels is unknown for most patients. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients.

References

  1. Dickson RA, Dalby JT, Williams R, Edwards AL "Risperidone-induced prolactin elevations in premenopausal women with schizophrenia." Am J Psychiatry 152 (1995): 1102-3
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  4. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  5. Meco G, Falaschi P, Casacchia M, et al "Neuroendocrine effects of haloperidol decanoate in patients with chronic schizophrenia." Adv Biochem Psychopharmacol 40 (1985): 89-93
  6. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  7. Bai YM, Ciu HJ, Guo ZZ "Risperidone-induced hyperprolactinemia in an elderly woman." Am J Psychiatry 159 (2002): 2112
  8. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  9. Huang ML, Van Peer A, Woestenborghs R, De Coster R, Heykants J, Jansen AA, Zylicz Z, Visscher HW, Jonkman JH "Pharmacokinetics of the novel antipsychotic agent risperidone and the prolactin response in healthy subjects." Clin Pharmacol Ther 54 (1993): 257-68
  10. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  12. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  13. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  14. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  15. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  16. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
View all 16 references
Moderate

Neuroleptics (Includes Versacloz) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

Most neuroleptic agents are extensively metabolized by the liver. The plasma concentrations of these agents may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with neuroleptic agents should be administered cautiously in patients with significant liver disease. Lower initial dosages and slower titration may be appropriate.

References

  1. Hobbs DC "Metabolism of thiothixene." J Pharm Sci 57 (1968): 105-11
  2. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  4. Jann MW, Grimsley SR, Gray EC, Chang WH "Pharmacokinetics and pharmacodynamics of clozapine." Clin Pharmacokinet 24 (1993): 161-76
  5. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  6. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  7. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  8. Hobbs DC, Welch WM, Short MJ, Moody WA, Van der Velde CD "Pharmacokinetics of thiothixene in man." Clin Pharmacol Ther 16 (1974): 473-8
  9. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  10. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
View all 11 references
Moderate

Neuroleptics (Includes Versacloz) ↔ Parkinsonism

Moderate Potential Hazard, Moderate plausibility

Applies to: Parkinsonism

The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects, and their use may be contraindicated in patients with Parkinson's disease or parkinsonian symptoms.

References

  1. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  2. Moleman P, Janzen G, von Bargen BA, et al "Relationship between age and incidence of parkinsonism in psychiatric patients treated with haloperidol." Am J Psychiatry 143 (1986): 232-4
  3. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  4. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  5. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  6. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  7. Mahmood T, Clothier EB, Bridgman R "Risperidone-induced extrapyramidal reactions." Lancet 346 (1995): 1226
  8. Gwinn KA, Caviness JN "Risperidone-induced tardive dyskinesia and parkinsonism." Mov Disord 12 (1997): 119-21
  9. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  10. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  11. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  12. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  13. Bransgrove LL, Kelly MW "Movement disorders in patients treated with long-acting injectable antipsychotic drugs." Am J Hosp Pharm 51 (1994): 895-9
  14. Owens DGC "Extrapyramidal side effects and tolerability of risperidone - a review." J Clin Psychiatry 55 Suppl (1994): 29-35
View all 14 references

Versacloz (clozapine) drug Interactions

There are 1331 drug interactions with Versacloz (clozapine)

Versacloz (clozapine) alcohol/food Interactions

There are 5 alcohol/food interactions with Versacloz (clozapine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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