Clozaril is given to help people with severe schizophrenia who have failed to respond to standard treatments. Clozaril is not a cure, but it can help some people return to more normal lives. Even though it does not produce some of the disturbing side effects of other antipsychotic medications, Clozaril may cause agranulocytosis, a potentially lethal disorder of the white blood cells. Due to the risk of agranulocytosis, anyone who takes Clozaril is required to have a blood test once a week for the first 6 months.


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CLOZARIL may cause drowsiness or dizziness. Use caution performing tasks that require alertness. Other side effects include stomach upset, constipation, dry mouth, headache, tremor and increased salivation. If these effects persist or worsen, notify your doctor. To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use saliva substitute. Notify your doctor promptly if you develop: chest pain, a rapid heart rate, difficulty breathing, aching muscles and joints, rash, leg swelling/pain, a sore throat, fever, weakness, flu-like symptoms, seizures, a change in the amount of urine. To prevent excessive dizziness, rise slowly from a flat or seated position. Avoid sudden changes in posture and be careful on stairs. If you notice other effects not listed above, contact your doctor or pharmacist.

Take CLOZARIL exactly as directed. Do not take it more often or increase the dose without your doctor's approval. Do not suddenly stop taking CLOZARIL without notifying your doctor. Your dose may need to be gradually decreased. During the first few weeks of treatment, your dose may be adjusted until the best dose is identified. It may take several weeks for the full benefit of the drug to occur.

CLOZARIL WARNING:

Because clozapine has caused severe, even fatal, blood disorders (agranulocytosis), clozapine should be used only for severely ill patients who have failed to respond to other therapies. At least two other standard antipsychotic drugs should be tried before trying clozapine. Clozapine may cause seizures, especially when higher amounts of clozapine are used. Inform your doctor if you have a history of seizures. You should not perform activities where sudden loss of consciousness could cause serious risk to yourself or others (e.g., operating machinery, driving, swimming). Dizziness upon standing (with or without fainting) may occur with the use of CLOZARIL and has rarely resulted in lung and heart failure. Tell your doctor if you are using other psychiatric medications because these problems have occurred in people using these other medications. Dizziness may occur at the first dose or during quick dose increases. If you miss doses for a short period of time (2 days or greater since the last dose), contact your doctor since you may need to restart using smaller doses of clozapine. If you develop symptoms of an infection (such as fever, chills, or a persistent sore throat), unusual fatigue, difficulty breathing, a rapid heart rate, or dizziness, promptly notify your doctor. Your doctor will monitor your blood cells before your therapy begins and during treatment. White blood cell testing must continue once a week for four weeks after you stop using this.

Tell your doctor your medical history, especially of: glaucoma, seizure disorders, heart or blood vessel problems, kidney of liver disease, enlarged prostate, blood disorders, diabetes, allergies. Limit alcohol intake which can lead to excessive drowsiness or dizziness. Women who are pregnant or plan to become pregnant should inform their doctors. Do not breast-feed while taking clozapine.

Tell your doctor of all prescription and nonprescription medications you may use, especially of: drugs used for high blood pressure, "blood thinners" such as warfarin, digoxin, narcotic pain medications (e.g., codeine), SSRI antidepressants (particularly fluvoxamine). Also tell your doctor if you are taking any medication to decrease stomach acid or lessen abdominal cramping. Do not start or stop any medicine without doctor or pharmacist approval.

If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include nausea, disorientation, unsteadiness, decreased sexual ability, prolonged or painful erection in males, seizures, and loss of consciousness.

Management of Overdose

Establish and maintain an airway; ensure adequate oxygenation and ventilation. Activated charcoal, which may be used with sorbitol, may be as or more effective than emesis or lavage, and should be considered in treating overdosage. Cardiac and vital signs monitoring is recommended along with general symptomatic and supportive measures. Additional surveillance should be continued for several days because of the risk of delayed effects. Avoid epinephrine and derivatives when treating hypotension, and quinidine and procainamide when treating cardiac arrhythmia.
There are no specific antidotes for CLOZARIL. Forced diuresis, dialysis, hemoperfusion and exchange transfusion are unlikely to be of benefit.