Atypical Neuroleptics

A. Clozapine (Clozaril) is a dibenzodiazepine derivative and is considered an atypical antipsychotic agent.

1. Clozapine is used for the treatment of patients who have not responded to, or who cannot tolerate, other neuroleptics.

2. Clozapine is associated with a 1 % incidence of agranulocytosis, which can be fatal. New guidelines are expected to recommend monitoring of WBC weekly for the first six months of treatment and every two weeks thereafter. When white blood cell counts drop below 3 x 1012/liter, clozapine must be discontinued.

3. Eosinophilia (>4000/mm3) may be a precursor of leukopenia. Clozapine should be interrupted until count is below 3000mm3.

4. Clozapine is unique in that it does not produce extrapyramidal symptoms or tardive dyskinesia.

5. Seizures are especially common at dosages above 600 mg per day.

6. Clozapine causes sedation, orthostatic hypotension, excess salivation (sialorrhea), weight gain, tachycardia, and, rarely, respiratory arrest in conjunction with benzodiazepines may also occur.

7. There is no significant elevation of prolactin or subsequent side effects.

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