Clozapine (Clozaril)

Clozaril is a unique antipsychotic mood stabilizer, highly effective in many cases when no other medication has been. Not only the mood changes improve on it, it often improves thinking, impulse control and decision-making. It often prevents repeated admissions or need for long-term placements.

Many psychiatrists however are unfamiliar with and avoid it. This is because on very rare cases, it can cause serious side effect of agranulocytosis (drop in the infection fighting white blood cells).

We, however, have been able to reduce this risk significantly by using a very careful process as noted bellow:

• Blood tests (CBC) are done prior to start of Clozaril and weekly thereafter, to ensure that WBCs are normal. The pharmacy will not dispense the medication without these results. These tests can be reduced to every 2 weeks, if the blood counts have been normal for 6 months and to once a month after a year.
• The usual therapeutic dose is 200-300 mg/ day, but it will start at the very small dose of 12.5 mg /day. The dosage then is increased at increments of 25-50 mg, at frequency of no shorter than 3 days. I do it more cautiously and at 25 mg increments.
• If for some reason your child skips taking it for a week or more, it should be resumed at a small dose once again.
• Not all pharmacies are set up to dispense it. Be sure to ask your pharmacy prior to the discharge, if they dispense Clozaril.

Agranulocytosis and other potential side effects:

• Report signs of any infection (such as fever) to your doctor. Almost these symptoms are due the common illnesses that everyone gets (cold and flu). To be on the safe side, however, I recommend an examination and/or blood tests, even if it seems to be a common cold.
• Constipation is a frequent side effect. While constipation for a short period of time is not serious, a very prolonged period can be. Please monitor that your child is having regular bowel movements.
• Cardiac problems are very rare. Any unexplainable tiredness or shortness of breath should be reported to your doctors immediately. Your child should have routine EKGs and comprehensive blood test once or twice per year.
• Lithium is a mood stabilizing medication for treatment of bipolar disorders. It however can also counteract the lowering of the white blood cells cause by Clozaril (though this has not been proven with studies). I use it in some patients for this purpose. Make sure that your doctor knows the reason for it and not stop it, thinking that it is an unnecessary mood stabilizer.

These are only a partial list of potential side effects. You should discuss any concerns or questions with your physician.