Clozapine
Brand: Clozaril, Versacloz
Boxed warning
Severe neutropenia, orthostatic hypotension with syncope, seizures, myocarditis and cardiomyopathy, and increased mortality in elderly patients with dementia-related psychosis.
- Caution
- Severe neutropenia: absolute neutrophil count is monitored on the schedule in the label (weekly at first, then less often). The Clozapine REMS was eliminated by FDA in February 2025, so pharmacies no longer verify ANC through a REMS before dispensing.
Common side effects
- Severe drop in white cells (neutropenia)
- Drooling
- Sedation
- Weight gain and high blood sugar
Key interactions
- Additive marrow suppression with other such drugs
- Smoking cessation raises clozapine levels
- Caffeine raises its level
Counseling points
- Absolute neutrophil count is monitored on a set schedule
- Report fever, sore throat, or any sign of infection at once
- Tell the prescriber if you start or stop smoking
- Rise slowly: blood pressure can drop
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