Name of Drug Dosage, Route, Frequency Mechanism of Action Indications Contraindications Adverse Reactions Nursing Responsibilities

Generic Name : Adults Clozapine has relatively Management of Drowsiness, dizziness, History of bone marrow Assessment
Clozapine weak dopamine severely ill headache; nausea, vomiting, disorders including
•Initial therapy: receptor-blocking schizophrenics who constipation; anxiety, agranulocytosis, •History:
Brand Name: 12.5 mgPO once or twice daily. If activity at D1, D2, are unresponsive to confusion, fatigue, transient circulatory collapse, Allergy to clozapine,
using orally disintegrating D3and D5 standard antipsychotic fever. Rarely, dysphagia, alcoholic or toxic myeloproliferative disorders,
Clozaril,FazaClo, Gen-
tablets, begin with ½ (12.5 mg) receptors but has high drugs acute pancreatitis, psychosis, drug history of clozapine-induced
Clozapine (CAN)
of a 25-mg tablet and destroy affinity for the D4 cholestatic jaundice; intoxication, uncontrolled agranulocytosis or severe
receptor. It has also •Reduction of the risk orthostatic hypotension, epilepsy, severe renal,
Classification: the remaining half. Continue to granulocytopenia, severe CNS
of recurrent suicidal tachycardia; seizures; hepatic or cardiac
25 mg PO daily or bid; then blocking effects on depression, comatose states,
Antipsychotic,Dopami behavior in patients hypersalivation. disease; paralytic ileus.
gradually increase with daily serotonin, α- history of seizure disorders, CV
nergicblocker with schizophrenia or Pregnancy and lactation
increments of 25–50 mg/day, if adrenergichistamine •Potentially Fatal: disease, narrow-angle glaucoma,
H1 and cholinergic schizo affective
Pregnancy Category B tolerated, to a dose of 300–450 Rarely, thromboembolism. lactation, pregnancy
disorder (not orally
mg/day by the end of second receptors. Reversible neutropenia •Physical:
disintegrating tablet
week. Adjust later dosage no which may progress to a T, weight; reflexes, orientation,
more often than twice weekly in potentially fatal IOP, ophthalmologic examination;
increments <100 mg. Do not agranulocytosis. Fatal P, BP, orthostatic BP, ECG; R,
exceed 900 mg/day. myocarditis. adventitious sounds;
•Maintenance: bowelsounds, normal output,
Maintain at the lowest effective liver evaluation; prostate
dose for remission of symptoms. palpation, normal urine output;
• Discontinuation of therapy: CBC, urinalysis, LFTs, renal
Gradual reduction over a 2-wk functiontests, EEG
period is preferred. If abrupt
discontinuation is required, Interventions
carefully monitor patient for •BLACK BOX WARNING:
signs of acute psychotic Use onlywhen unresponsive to
symptoms. conventional antipsychotic drugs;
• Reinitiation of treatment: risk of serious CV and respiratory
Follow initial dosageguidelines, effects.
use extremecare; increased risk •Dispense only 1 wk supply at a
of severe adverse effect swith time.
re-exposure. •Monitor WBC carefully prior to
first dose.
Pediatric Patients •BLACK BOX WARNING:
• Safety and efficacy in patients Weekly monitoring of WBC
< 16 yr not established. during treatmentand for 4 wk
there after. Dosage maybe
adjusted based on WBC count.
Potentially fatal agranulocytosis
has been reported.
•Monitor T.
If fever occurs, rule out
underlying infection, and consult
physician for comfort measures.
Monitor elderly patients
for dehydration. Institute
remedialmeasures promptly;
sedation anddecreased thirst
related to CNS effectscan lead to
dehydration.
•Monitor patient regularly for
signs and symptoms of diabetes
mellitus.
•Encourage voiding before taking
drug to decrease anticholinergic
effects of urinary retention.