What do you monitor clozapine with?
Monitoring clozapine patients Baseline blood tests should check white cell count, troponins, CRP and possibly BNP3. Patients with a history of cardiac disease or abnormal cardiac findings on examination (such as QT prolongation) should be referred to a cardiologist7.
Does clozapine need to be monitored?
WHEN TREATMENT WITH CLOZARIL® (clozapine) IS DISCONTINUED (REGARDLESS OF THE REASON), WBC COUNT AND ANC MUST BE MONITORED WEEKLY FOR AT LEAST 4 WEEKS FROM THE DAY OF DISCONTINUATION OR UNTIL WBC ≥3500/mm3 AND ANC ≥2000/mm3.
What are nursing considerations for clozapine?
Patient teaching – Patients must immediately report symptoms of infection, especially flu-like symptoms. – Avoid hot baths or showers as hypotension can occur. – Oral hygiene is important to avoid oral candidiasis. – Avoid overexposure to the sun as heatstroke can occur.
What should I check before starting clozapine?
Timing of blood tests Patients newly started on clozapine must have an FBC taken weekly for the first18 weeks of treatment then fortnightly for the next 34 weeks. After that they receive monthly monitoring for as long as they are taking clozapine.
How do you titrate clozapine?
The standard titration starts with clozapine 25 mg daily given in 2 divided doses, and then clozapine is increased by 25-50 mg per day each day until desired efficacy. The typical maintenance dose of clozapine is 300-450 mg daily.
When do you measure clozapine levels?
No sooner than two to three weeks after treatment initiation and only where dose has been stable for at least the preceding 5 days. To ensure the result represents a trough level, take sample immediately before the morning dose or 10-12 hours post-dose where only one dose is taken per day.
Does clozapine require blood profile monitoring?
In the United States, the Food and Drug Administration requires regular blood count monitoring of all patients taking clozapine. An uncommon but serious side effect of clozapine is severe neutropenia, defined as an absolute neutrophil count (ANC) less than 500/μL.
Does clozapine have a black box warning?
Clozaril carries five serious warnings, called black box warnings, about possible severe side effects and drug interactions. 2 Because of these warnings, Clozaril can only be prescribed through a special program that restricts distribution called the Clozapine Risk Evaluation and Mitigation Strategies (REMS) Program.
How does clozapine administered?
Clozapine comes as a tablet, an orally disintegrating tablet (tablet that dissolves quickly in the mouth), and an oral suspension (liquid) to take by mouth. It is usually taken once or twice daily. Take clozapine at around the same time(s) every day.
Why does clozapine slowly titrate?
Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response.
When do you draw clozapine levels?
Clozapine reaches a steady-state concentration at 5-7 days. Levels should be drawn 12 hours (± 2 h) after the last dose. Clozapine blood levels are correlated with both clozapine effectiveness and side effects.
How do you draw clozapine levels?
Obtaining clozapine levels Measure clozapine as steady-state trough levels. I usually draw them 12 hours after the last dose (such as in the morning after the nightly dose) and several days after treatment begins.
Does clozapine cause heart disease?
Your doctor will discuss the risks of the treatment with you before you start taking clozapine. In particular, clozapine can cause heart problems and blood disorders. You will be given regular check-up appointments so that your doctor can monitor you for any evidence of these.
What are the side effects of clozapine?
constipation,
Is clozapine a controlled drug?
Clozapine (marketed as Clozaril, Fazaclo ODT, Versacloz and generics) is an antipsychotic medicine used to treat schizophrenia in patients whose symptoms are not controlled with standard antipsychotic drugs. Clozapine is also used in patients with recurrent suicidal behavior associated with schizophrenia or schizoaffective disorder.
Does clozapine help with anxiety?
The level of anxiety and the degree of aggressive behaviour of the patients did not vary significantly during the year before clozapine treatment. Significant decrease in anxiety and aggressive behaviour was noted already after 3 months of clozapine therapy.