Clozapine

Generic Details

Generic Name

Clozapine

Other Names

  • Clozaril
  • Leponex

Drug Class

  • Atypical antipsychotic

Chemical Formula

C18H19ClN4

Molecular Weight

326.82 g/mol

Mechanism of Action

  • Potent antagonist at multiple neurotransmitter receptors, including dopamine and serotonin receptors

Indications

  • Schizophrenia
  • Treatment-resistant schizophrenia
  • Reduction of suicidal behavior in schizophrenia patients

Common Dosage Forms

  • Tablet
  • Oral suspension

Typical Dosage

  • 25-50 mg once or twice daily, gradually titrated to 300-450 mg per day (divided doses)

Pediatric Dosage

  • Children under 16 years should avoid unless other treatments are ineffective

Geriatric Dosage

  • Lower initial doses and slower titration due to increased sensitivity

Side Effects

  • Agranulocytosis
  • Seizures
  • Myocarditis
  • Weight gain
  • Dizziness
  • Sedation

Contraindications

  • History of clozapine-induced agranulocytosis or severe granulocytopenia
  • Uncontrolled epilepsy or myeloproliferative disorders

Pregnancy Category

  • Category B - No evidence of risk in humans

Lactation Safety

  • Limited data, caution advised

Drug Interactions

  • Fluvoxamine, ciprofloxacin, paroxetine - increase clozapine levels
  • Carbamazepine, phenytoin - decrease clozapine levels

Overdose Symptoms

  • Drowsiness, tachycardia, hypotension, respiratory depression

Antidote for Overdose

  • No specific antidote, symptomatic treatment

Storage Conditions

  • Store at room temperature away from light and moisture

Pharmacokinetics

  • Absorption: Rapidly and well absorbed after oral administration
  • Distribution: Widely distributed throughout the body
  • Metabolism: Extensively metabolized in the liver via CYP1A2 and CYP3A4 enzymes
  • Excretion: Primarily excreted in urine and feces

Precautions

  • Regular monitoring of ANC (absolute neutrophil count) due to risk of agranulocytosis
  • Cardiac monitoring due to risk of myocarditis

Warnings

  • Risk of severe neutropenia and agranulocytosis. Regular blood monitoring required.