DE Jesus, Glenn Paul D.

N4-1
Generic
Name/ Trade
Name

Classification

Indication

Mechanism of Action

Adverse Reactions

Drug Interaction

Antipsychotic

Management
of severely ill
schizophrenic
s who are
unresponsive
to standard
ntipsychotic
drugs.

Mechanism not fully

understood. Blocks
dopamine receptors
in the brain,
depresses the RAS;
antcholinergic,
antihistaminic (H1),
and alphaadrenergic blocking
activitymay
contribute to some
of its therapeutic
(and adverse) and
actions. Clozapine
produces fewer
extrapyramidal
effects than other
antipsychotics.

CNS: Drowsiness,
sedation seizures,
dizziness,
syncope,
headache,
tremor, disturbed
sleep,
nightmares,
restlessness,
agitation,
increase
salivation,
sweating, tardive
dyskinesia,
neuroleptic
malignant
syndrome
CV: Tachycardia,
hypotension,hype
rtension, ECG
changes,
potentially fatal
myocarditis
GI: Nausea,
Vomiting,
constipation,
abnormal

Drug-drug
Increased
therapeutic and
toxic effects
with cimetidine,
caffeine, other
CYP450
inhibitors
Decreased
therapeutic
effects with
phenytoin,
ethotoin, other
CYP450
inducers

Clozapine
Dopaminergic
blocker

Reduction of
the risk of
recurrent
suicidal
behavior in
patients with
schizophrenia
or
schizoaffectiv
e disorder
(not orally
disintegrating
tablet)

Route,
Nursing
Frequency Consideration
/
Dosage
Adults
Black box
Initial
warning.
therapy
Use only
: 12.5
when
mg PO
unresponsiv
once or
e to
twice
conventional
daily. If
antipsychoti
using
c drugs; risk
orally
of serious CV
disinteg
and
rating
respiratory
tablets,
effects.
begin
Obtain
with
clozapine
one half through the
(12.5m
clozaril
g) of a
patient
25mg
assistance
tablet
program.
and
Dispense
destroy only 1 week
the
supply at a
remaini
time.
ng half. Monitor WBC
Continu
carefully
e to 25
prior to first

discomfort, dry
mouth
GU: Urinary
abnormalities
Hematologic:
Leukopenia,
agranuloytosis
Other: fever,
weight gain, rash,
development of
diabetes mellitus

mg PO
daily
increme
nts of
25-50
mg/day
, if
tolerate
d, to a
dose of
300450
mg/day
by the
end of
second
week.
Adjust
later
dosage
no
more
often
than
twice
weekly
in
increme
nts of
less
than
100
mg. do
not
exceed
900

dose.
Black box
warning.
Weekly
monitoring
of WBC
during
treatment
and for 4
week
thereafter.
Dosage must
be adjusted
based on
WBC count.
Potentially
fatal
agranulocyto
sis has been
reported.
Monitor
temperature.
If fever
occurs, rule
out
underlying
infection,
and consult
physician for
comfort
measures.
Black box
warning.
Monitor for
seizures, risk
increases as

mg/day.

Mainten
ance:
Maintai
n at the
lowest
effectiv
e dose
for
remissi
on of
sympto
ms.

Disconti
nuation
of
therapy
:
Gradual
reducti
on over
a 2week
period
is
preferre
d. If
abrupt I
disconti
nuation
is
require
d,,
carefull

dose
increases.
Monitor
elderly
patients for
dehydration.
Institute
remedial
measures
promptly;
sedation and
decreased
thirst related
to CNS
effects can
lead to
dehydration.
Monitor
patient
regularly for
signs and
symptoms of
diabetes
mellitus.
Encourage
voiding
before taking
drug to
decrease
anticholinerg
ic effects of
urinary
retention.
Follow
guidelines
for

y
monitor
patients
for
signs of
acute
psychot
ic
sympto
ms.

Reinitia
tion of
treatme
nt:
Follow
initial
dosage
guidelin
es, use
extrem
e care,
increas
ed risk
of
severe
adverse
effects
with reexposur
e.

Reference:

2009, Lipicotts Nursin Drug Guide

discontinuati
on or reinstitution of
the drug.
Encourage
patient on
seriousness
of potential
agranulocyto
sis.