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Use should be avoided; discontinue drug or discontinue nursing taking into consideration importance of drug to mother. Duggal HS, Mendhekar DN. Clozapine-induced tardive dystonia blepharospasm. J Neuropsychiatry Clin Neurosci. Naber D, Grohmann R, Muller-Spahn F et al. Efficacy and adversive effects of clozapine in the treatment of schizophrenia and tardive dyskinesia. Psychopharmacology. May cause side effects to become worse. labetalol

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This information is generalized and not intended as specific medical advice. Clozaril may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation. AstraZeneca Pharmaceuticals. Seroquel quetiapine fumarate tablets prescribing information. Wilmington, DE; 2004 Jul. Prior to initiating treatment with Clozaril, perform a careful physical examination, medical history, and concomitant medication history. Consider obtaining a baseline ECG and serum chemistry panel. Correct electrolyte abnormalities. Discontinue Clozaril if the QTc interval exceeds 500 msec. In patients with remitted first or multiple episodes, APA recommends either indefinite maintenance therapy or gradual discontinuance of the antipsychotic with close follow-up and a plan to reinstitute treatment upon symptom recurrence.

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Tell your doctor all medications and supplements you use. Clozaril is not expected to be harmful to an unborn baby. Do not use clozapine without telling your doctor if you are pregnant or plan to become pregnant during treatment. Clozapine can pass into breast milk and may harm a nursing baby. Breastfeeding while using Clozaril is not recommended. Müller P, Heipertz R. Zur Behandlung manischer Psychosen mit Clozapin. German; with English abstract. Has been used in the management of childhood-onset schizophrenia in a limited number of treatment-resistant children and adolescents. 319 323 Because of the risk of severe toxicity, the American Academy of Child and Adolescent Psychiatry AACAP states that clozapine should be reserved for treatment-refractory pediatric patients who have failed to respond to adequate therapeutic trials of at least 2 other first-line antipsychotic agents.

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Disclaimer: Every effort has been made to ensure that the information provided by Multum, Truven Health Analytics, Inc. Murray AM, Waddington JL. Behavioral indices of the interaction of clozapine with D 1 and D 2 dopamine receptors. Br J Pharmacol. Clozaril may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor right away if you notice any signs of infection like fever, sore throat, rash, chills, mouth or nose sores, or unusual tiredness or weakness.

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Concomitant use is not recommended. ESR increased, sepsis, thrombocytosis, and thrombocytopenia. Eli Lilly and Company. Zyprexa olanzapine tablets and Zyprexa Zydis olanzapine orally disintegrating tablets prescribing information. Efficacy thought to be principally mediated through antagonist activity at dopamine type 2 D 2 and serotonin type 2A 5-HT 2A receptors. Lewis-Hall F. Dear health care professional letter regarding class labeling for atypical antipsychotics and risk of hyperglycemia and diabetes. Princeton, NJ: Bristol-Myers Squibb Company; 2004 Mar 25. From FDA website. Simpson GM, Lee JH, Shrivastava RK. Clozapine in tardive dyskinesia. Psychopharmacology. Clozaril may increase the risk of death when used to treat mental problems caused by dementia in elderly patients. Most of the deaths were linked to heart problems or infection. Clozaril is not approved to treat mental problems caused by dementia. Burki HR, Ruch W, Asper H et al. Pharmakologische und neurochemische Wirkungen von Clozapin: neue Gesichtspunkte in der medikamentosen Behandlung der Schizophrenie. German; with English abstract. Your blood levels of clozapine may increase. You may experience a fast heartbeat, weakness, fatigue, dizziness, increased salivation, or decreased breathing. With citalopram or escitalopram, your risk of an irregular heartbeat may increase, which may be life-threatening. Effects may be dose-related; consider dosage reduction in patients experiencing such effects. 1 See Advice to Patients.

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Rebec GV, Anderson GD. Regional neuropharmacology of the antipsychotic drugs: implications for the dopamine hypothesis of schizophrenia. Behav Assessment. Bushe C, Leonard B. Association between atypical antipsychotic agents and type 2 diabetes: review of prospective clinical data. Br J Psychiatry Suppl. If your symptoms do not improve or if they become worse, check with your doctor. The total daily dose can be increased in increments of 25 mg to 50 mg per day, if well-tolerated, to a target dose of 300 mg to 450 mg per day administered in divided doses by the end of 2 weeks. Subsequently, the dose can be increased weekly or twice weekly, in increments of up to 100 mg. The maximum dose is 900 mg per day. Carvey PM, Nath ST, Kao LC et al. Clozapine fails to prevent the development of haloperidol-induced behavioral hypersensitivity in a cotreatment paradigm. Eur J Pharmacol. donepezil

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Clozapine concentrations may be increased in patients with clinically important renal impairment. 1 See Special Populations under Dosage and Administration. Woosley RL, Romero KA. www. Ingram DM, Nottage EM, Roberts AN. Prolactin and breast cancer risk. Med J Aust. Richelson E, Nelson A. Antagonism by neuroleptics of neurotransmitter receptors of normal human brain in vitro. Eur J Pharmacol. Lindstrom LH. The effect of long-term treatment with clozapine in schizophrenia: a retrospective study in 96 patients treated with clozapine for up to 13 years. Acta Psychiatr Scand. Concomitant use of Clozapine Orally Disintegrating Tablets with other drugs metabolized by CYP2D6 can increase levels of these CYP2D6 substrates. Use caution when coadministering Clozapine Orally Disintegrating Tablets with other drugs that are metabolized by CYP2D6. It may be necessary to use lower doses of such drugs than usually prescribed.

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C until time of use. 395 Protect from moisture. Concomitant use of Clozaril and CYP1A2 inhibitors can increase plasma levels of clozapine, potentially resulting in adverse reactions. Kingsbury SJ, Puckett KM. Effects of fluoxetine on serum clozapine levels. Co-administration of citalopram and clozapine: effect on plasma clozapine levels. Clozapine Orally Disintegrating Tablets are available as peach, orally disintegrating tablets of 25 mg or 100 mg for oral administration without water. Clozapine Orally Disintegrating Tablets may be chewed. Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests. Serious, and possibly fatal, heart problems have rarely occurred in patients who take Clozaril. Symptoms may include chest pain; fast or irregular heartbeat; fever; rapid or difficult breathing; swelling of the hands, feet, or ankles; or unusual tiredness. Seek immediate medical attention if you experience any of these symptoms. Hartvig P, Eckernas SA, Lindstrom L et al. Receptor binding of N-methyl-11C clozapine in the brain of rhesus monkey studied by positron emission tomography PET. Psychopharmacology Berl. price propranolol 500 mg

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Undesirable alterations in lipids have occurred in patients treated with atypical antipsychotics, including clozapine. Clinical monitoring, including baseline and periodic follow-up lipid evaluations in patients using Clozapine Orally Disintegrating Tablets, is recommended. Relative oral bioavailability of 25- and 100-mg tablets is equivalent relative to an oral solution. 1 5 395 Conventional and orally disintegrating tablets of clozapine are bioequivalent. 5 395 Commercially available clozapine oral suspension and conventional tablets are bioequivalent. For first 6 months, monitor ANC every week; after 6 months of continuous therapy, if ANC remains in normal range, may monitor every 2 weeks. 1 408 After a further 6 months, if ANC continues to be in normal range, may reduce monitoring to every 4 weeks for the remainder of therapy. In managing overdosage, consider the possibility of multiple-drug involvement. NMS has occurred with Clozaril monotherapy and with concomitant CNS-active medications, including lithium. WILLWERTH Monday, Jul. 06, 1992 July 6, 1992. "". Time.

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Gianutsos G, Moore K. Possible significance of clozapine-induced increase in brain dopamine. Res Commun Chem Path Pharmacol. Simpson GM, Cooper TA. Plasma clozapine levels and convulsions. Am J Psychiatry. Kane JM. The current status of neuroleptic therapy. J Clin Psychiatry. QT Interval Prolongation: Advise patients to consult their clinician immediately if they feel faint, lose consciousness or have signs or symptoms suggestive of arrhythmia. Instruct patients to not take Clozaril with other drugs that cause QT interval prolongation. CNS pathology, central anticholinergic toxicity, extrapyramidal symptoms, and drug fever. Inhibitors or inducers of CYP1A2, CYP2D6, or CYP3A4: Potential pharmacokinetic interaction altered clozapine metabolism. Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position suddenly. These symptoms are more likely to occur when you begin taking this medicine, or when the dose is increased. Getting up slowly may help. If this problem continues or gets worse, check with your doctor. Kane JM, Cooper TB, Sachar EJ et al. Clozapine: plasma levels and prolactin response. Psychopharmacology. Risk of NMS, which can cause high fever, stiff muscles, sweating, fast or irregular heart beat, change in BP, confusion, and kidney damage. Gerlach J, Koppelhus P, Helweg E et al. Clozapine and haloperidol in a single-blind cross-over trial: therapeutic and biochemical treatment of schizophrenia. Acta Psychiatr Scand. Hepatobiliary System: Cholestasis, hepatitis, jaundice, hepatotoxicity, hepatic steatosis, hepatic necrosis, hepatic fibrosis, hepatic cirrhosis, liver injury hepatic, cholestatic, and mixed and liver failure. Lieberman JA, Kane JM, Johns CA. Clozapine: guidelines for clinical management. J Clin Psychiatry. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups. is buying bimatoprost

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AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details. Chiu E, Burrows G, Stevenson J. Double-blind comparison of clozapine with chlorpromazine in acute schizophrenic illness. Aust NZ J Psychiatry. See Tables 2 or 3 for appropriate ANC monitoring based on the level of neutropenia if abrupt treatment discontinuation is necessary because of moderate to severe neutropenia. It may be necessary to increase the Clozapine Orally Disintegrating Tablets dose if used concomitantly with inducers of these enzymes. Administer orally as conventional tablets, orally disintegrating tablets, 1 2 5 10 11 12 54 59 61 62 63 87 102 120 156 237 253 255 395 400 or oral suspension 406 without regard to meals. 1 5 218 219 395 406 See Food under Pharmacokinetics. Flood JG. Serum levels of clozapine and norclozapine in patients treated with selective serotonin reuptake inhibitors.

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ANC monitoring schedule as before treatment interruption. 1 395 408 See Severe Neutropenia under Cautions. Panteleeva GP, Kovskaya MYT, Belyaev BS et al. Clozapine in the treatment of schizophrenic patients: an international multicenter trial. Clin Ther. St. John's wort or vitamin supplements. Haddy TB, Rana SR, Castro O. Benign ethnic neutropenia: what is a normal absolute neutrophil count? Clozapine Orally Disintegrating Tablets must remain in the original package until used by the patient. Brenmer KE, Hassan PC December 1997. Cold JA, Wells BG, Froemming JH. Seizure activity associated with antipsychotic therapy. DICP. Gosselin RE, Smith RP, Hodge HC et al. Clinical toxicology of commercial products. Chen JP, Paredes W, Gardner EL. Chronic treatment with clozapine selectively decreases basal dopamine release in nucleus accumbens but not in caudate-putamen as measured by in vivo brain microdialysis: further evidence for depolarization block. Neurosci Lett. WH, Lin SK, Tseng YT, Jann MW. January 1999. Citrome LL. Efficacy should drive atypical antipsychotic treatment. BMJ. Robins. Quinidex Extentabs prescribing information. In: Barnhart ER, publisher. Clary CM. Dear health care practitioner letter regarding class labeling for atypical antipsychotics and risk of hyperglycemia and diabetes. New York NY: Pfizer Global Pharmaceuticals; 2004 Aug. From the FDA website. Study. This was an adequate and well-controlled, 2-year study evaluating the efficacy of clozapine relative to olanzapine in reducing the risk of suicidal behavior in patients with schizophrenia or schizoaffective disorder. The rates are not adjusted for duration of exposure. Philippides GJ, Roden DM, Zareba W. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. biaxin

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Seizures may occur in patients who take Clozaril, which may cause you to suddenly lose consciousness. Avoid activities in which loss of consciousness could be dangerous to you or others eg, driving, swimming, climbing, operating machinery. Conley RR, Schultz C, Baker RW et al. Clozapine efficacy in schizophrenic nonresponders. Psychopharmacol Bull. The total daily dose can be increased in increments of 25 mg to 50 mg per day, if well-tolerated, to achieve a target dose of 300 mg to 450 mg per day administered in divided doses by the end of 2 weeks. Subsequently, the dose can be increased once weekly or twice weekly, in increments of up to 100 mg. The maximum dose is 900 mg per day. do you need a prescription to toprol

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Prolongation of the QT interval, torsades de pointes and other life-threatening ventricular arrhythmias, cardiac arrest, and sudden death reported in clozapine-treated patients. 1 Risk factors include a history of QT-interval prolongation, long QT syndrome, family history of long QT syndrome or sudden cardiac death, significant cardiac arrhythmia, recent MI, uncompensated heart failure, and concomitant use of other drugs that prolong the QT interval or the metabolism of clozapine. 1 395 406 See Interactions. Periodically monitor serum electrolytes during clozapine therapy. FazaClo peel foil blister backing completely off the blister and gently remove tablet; do not push tablet through the foil. 395 Immediately place on the tongue to dissolve and swallow with or without liquid; tablet also can be chewed.

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Ghaznavi S, Nakic M, Rao P et al. Rechallenging with clozapine following neutropenia: treatment options for refractory schizophrenia. Am J Psychiatry. Engl J Med 329 3: 162-7. Hu XT, Wang RY. Haloperidol and clozapine: differential effects on the sensitivity of caudate-putamen neurons to dopamine agonists and cholecystokinin following one month continuous treatment. Brain Res. Moderate or weak CYP1A2 inhibitors or inhibitors of CYP2D6 or CYP3A4: Monitor for adverse effects and consider dosage reduction of clozapine. 1 If a moderate or weak CYP1A2 inhibitor or CYP2D6 or CYP3A4 inhibitor is discontinued, monitor for decreased efficacy of clozapine and consider increasing clozapine dosage.

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If clozapine-associated eosinophilia with systemic involvement is suspected, immediately discontinue clozapine. Metasearchengine for scientific literature. Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

If you notice any confusion, loss of coordination, feel like you might faint or lose consciousness, or are extremely sedated contact your doctor right away. Table 5. In addition, clozapine treatment was associated with categorical increases in serum total cholesterol and triglyceride, as illustrated in Table 6. The proportion of patients with categorical increases in total cholesterol or fasting triglyceride increased with the duration of exposure. The median duration of clozapine and chlorpromazine exposure was 45 days and 38 days, respectively. The clozapine dose range was 100 mg to 900 mg daily; the maximum chlorpromazine dose was 1800 mg daily.

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