pseudophaeochromocytoma.renal failure.systemic lupus
erythematosus (SLE)
SIDE-EFFECTS, FURTHER INFORMATIONHypersalivation
associated with clozapine therapy can be treated with
hyoscine hydrobromide [unlicensed indication], provided
that the patient is not at particular risk from the additive
antimuscarinic side-effects of hyoscine and clozapine.lPREGNANCYUse with caution.
lBREAST FEEDINGAvoid.
lHEPATIC IMPAIRMENTAvoid in symptomatic liver disease.
Avoid in progressive liver disease. Avoid in hepatic failure.
MonitoringMonitor hepatic function regularly.
lRENAL IMPAIRMENTAvoid in severe impairment.
lMONITORING REQUIREMENTS
▶Monitor leucocyte and differential blood counts. Clozapine
requires differential white blood cell monitoring weekly for
18 weeks, then fortnightly for up to one year, and then
monthly as part of the clozapine patient monitoring
service.
▶Close medical supervision during initiation (risk of
collapse because of hypotension and convulsions).
▶Blood lipids and weight should be measured at baseline, at
3 months (weight should be measured at frequent intervals
during thefirst 3 months), and then yearly with
antipsychotics. Patients taking clozapine require more
frequent monitoring of these parameters: every 3 months
for thefirst year, then yearly.
▶Fasting blood glucose should be measured at baseline, at
4 – 6 months, and then yearly. Patients taking clozapine
should have fasting blood glucose tested at baseline, after
one months’treatment, then every 4 – 6 months.
▶Patient, prescriber, and supplying pharmacist must be
registered with the appropriate Patient Monitoring
Service—it takes several days to do this.
lTREATMENT CESSATIONOn planned withdrawal reduce
dose over 1 – 2 weeks to avoid risk of rebound psychosis. If
abrupt withdrawal necessary observe patient carefully.
lDIRECTIONS FOR ADMINISTRATIONShake oral suspension
well for 90 seconds when dispensing or if visibly settled
and stand for 24 hours before use; otherwise shake well for
10 seconds before use. May be diluted with water.
lPRESCRIBING AND DISPENSING INFORMATIONClozapine
has been used for psychosis in Parkinson’s disease in
children aged 16 years and over.
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on how to administer clozapine oral
suspension.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Oral suspension
CAUTIONARY AND ADVISORY LABELS2, 10
▶Denzapine(Britannia Pharmaceuticals Ltd)
Clozapine 50 mg per 1 mlDenzapine 50 mg/ml oral suspension
sugar-free| 100 mlP£ 39. 60
Tablet
CAUTIONARY AND ADVISORY LABELS2, 10
▶Clozaril(Mylan)
Clozapine 25 mgClozaril 25 mg tablets| 28 tabletP£ 3. 02 |
84 tabletP£ 8. 40 (Hospital only)| 100 tabletP£ 10. 00
(Hospital only)
Clozapine 100 mgClozaril 100 mg tablets| 28 tabletP£ 12. 07
| 84 tabletP£ 33. 60 (Hospital only)| 100 tabletP£ 39. 00
(Hospital only)
▶Denzapine(Britannia Pharmaceuticals Ltd)
Clozapine 25 mgDenzapine 25 mg tablets| 84 tabletP£ 16. 64
| 100 tabletP£ 19. 80
Clozapine 50 mgDenzapine 50 mg tablets| 100 tabletP£ 39. 60
Clozapine 100 mgDenzapine 100 mg tablets| 84 tabletP
£ 66. 53 | 100 tabletP£ 79. 20
Clozapine 200 mgDenzapine 200 mg tablets| 100 tabletP
£ 158. 40
▶Zaponex(Leyden Delta B.V.)
Clozapine 25 mgZaponex 25 mg tablets| 84 tabletP£ 8. 28 |
500 tabletP£ 48. 39
Clozapine 100 mgZaponex 100 mg tablets| 84 tabletP£ 33. 88
| 500 tabletP£ 196. 43eiiiiF 244Olanzapine
lDRUG ACTIONOlanzapine is a dopamine D 1 ,D 2 ,D 4 , 5 -HT 2 ,
histamine- 1 , and muscarinic-receptor antagonist.lINDICATIONS AND DOSE
Schizophrenia|Combination therapy for mania
▶BY MOUTH
▶Child 12–17 years (under expert supervision):Initially
5 – 10 mg daily, adjusted according to response, usual
dose 5 – 20 mg daily, doses greater than 10 mg daily
only after reassessment, when one or more factors
present that might result in slower metabolism (e.g.
female gender, non-smoker) consider lower initial dose
and more gradual dose increase; maximum 20 mg per
day
Monotherapy for mania
▶BY MOUTH
▶Child 12–17 years (under expert supervision): 15 mg daily,
adjusted according to response, usual dose 5 – 20 mg
daily, doses greater than 15 mg daily only after
reassessment, when one or more factors present that
might result in slower metabolism (e.g. female gender,
non-smoker) consider lower initial dose and more
gradual dose increase; maximum 20 mg per daylUNLICENSED USENot licensed for use in children.
lCAUTIONSBone-marrow depression.hypereosinophilic
disorders.low leucocyte count.low neutrophil count.
myeloproliferative disease.paralytic ileus
lINTERACTIONS→Appendix 1 : olanzapine
lSIDE-EFFECTS
▶Common or very commonAnticholinergic syndrome.
appetite increased.arthralgia.asthenia.drowsiness.
eosinophilia.fever.glycosuria.hypersomnia.oedema.
postural hypotension.sexual dysfunction
▶UncommonAbdominal distension.alopecia.bradycardia.
breast enlargement.diabetes mellitus.diabetic coma.
dysarthria.epistaxis.ketoacidosis.memory loss.
oculogyration.photosensitivity reaction.
thromboembolism.urinary disorders
▶Rare or very rareHepatic disorders.hypothermia.
pancreatitis.rhabdomyolysis.thrombocytopenia
lPREGNANCYUse only if potential benefit outweighs risk;
neonatal lethargy, tremor, and hypertonia reported when
used in third trimester.
lBREAST FEEDINGAvoid—present in milk.
lHEPATIC IMPAIRMENT
Dose adjustmentsConsider initial dose of 5 mg daily.
lRENAL IMPAIRMENT
Dose adjustmentsConsider initial dose of 5 mg daily.
lMONITORING REQUIREMENTS
▶Blood lipids and weight should be measured at baseline, at
3 months (weight should be measured at frequent intervals
during thefirst 3 months), and then yearly with
antipsychotic drugs. Patients taking olanzapine require
more frequent monitoring of these parameters: every
3 months for thefirst year, then yearly.
▶Fasting blood glucose should be measured at baseline, at
4 – 6 months, and then yearly. Patients taking olanzapine
should have fasting blood glucose tested at baseline, after
one months’treatment, then every 4 – 6 months.BNFC 2018 – 2019 Psychoses and schizophrenia 251
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