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medication/ neuroleptics / clozapine

Another atypical neuroleptic: clozapine


  • Clozaril is only offered through a distribution network (RASC), requiring blood tests to be performed weekly or every 2 weeks, before the supply of Clozaril is released for the next period.

  • If the person's blood count is found to be abnormal in terms of white blood cells, the person should be given the status of prohibited from resuming treatment. She will never be able to take Clozaril again.

  • Particular attention should be paid to the appearance of symptoms resembling the flu or any other illness, in order to detect an immune problem in time.

  • Because of the risk of agranulocytosis and seizures, events to which people are constantly exposed during treatment, prolonged administration of Clozaril should generally be avoided in people who do not show the desired clinical response. The need for continued therapy should be reassessed periodically in persons who demonstrate an adequate clinical response.

  • Detect symptoms of diabetes, hyperglycemia, such as the frequent need to drink, urinate, eat, as well as feeling weak. Fasting blood glucose testing is recommended before and during treatment. Closer follow-up for people with multiple risk factors.

  • Weight gain must be assessed and managed. Professional monitoring of nutrition and exercise is recommended.

  • Evaluation before and during treatment of cholesterol and triglyceride levels.

  • Individuals should be assessed at least once a year and preferably by a neurologist for dyskinesia, dystonia, and tardive akathesia.

  • The liver, kidneys, heart, lungs and eyes should be evaluated before and at regular intervals during treatment.

  • It is necessary to titrate the drug slowly to allow people to get used to drowsiness and low blood pressure. The body will compensate once the target dose is reached.

Directions ​


Mental health problems

  • Should be reserved for the treatment of persons diagnosed with schizophrenia, in whom appropriate treatment with antipsychotics has proved ineffective or has caused intolerable side effects.

  • Reduction in suicidal behavior.

Contraindications ​


Physical health issues

  • People who have problems with the spinal cord where the production of white blood cells comes from

  • People who have suffered from agranulocytosis or other diseases associated with the destruction of white blood cells

  • Various liver problems. Close monitoring required

  • kidney problems

  • Serious heart and respiratory problems

  • History of uncontrolled seizures or epilepsy

  • Allergic reaction to Clozaril

  • Prostate hypertrophy

  • Angle-Closure Glaucoma

  • Paralytic ileus (intestinal obstruction due to paralysis of the small intestine when there is no physical obstacle)

  • People suffering from or with a history of diabetes, hyperglycemia, high cholesterol and triglycerides

  • People unable to undergo repeated blood tests



May be particularly susceptible to low blood pressure, urinary retention and constipation associated with taking Clozaril


Pregnancy and breast feeding

Should not be prescribed

Drugs interactions​

Be careful not to take any medicine, with or without a prescription, without consulting a doctor or pharmacist to identify the risks of interaction.


Psychiatric drugs

  • May increase the effects:

> Antidepressants

> Anxiolytics and sleeping pills

> Narcotics

> Medicines for allergies

> Antipsychotics

  • May reduce the increase in blood pressure caused by norepinephrine and epinephrine

  • Should not be used with Tegretol because  the latter drug shows potential to suppress the production of white blood cells from the spinal cord


Physical health drugs

May increase the effects:

> Sedating antihistamines  (medicines for allergies)

> Antihypertensives (medicines for high blood pressure)

> Antiarrhythmics and beta-blockers  (heart medications)



May increase the effects of alcohol

Side effects​

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.



  • Dizziness

  • Dry mouth

  • Headache

  • Seizures

  • Myoclonus (rapid, involuntary, low amplitude muscle contraction of one or more muscles)



  • Can cause a drop in blood pressure when the person stands up, which can lead to dizziness, falls

  • Can cause cardiac arrest



  • Constipation

  • Diarrhea

  • Difficulty urinating

  • Frequent need to urinate



  • Sexual problems including:

> Decreased libido

> Ejaculation problem

> Erection problem

  • Cessation of menstruation

  • Priapism (persistent and painful erection appearing without sexual arousal)



Weight gain which may be rapid, considerable, irreversible



  • May cause type 2 diabetes, hyperglycemia

  • May increase cholesterol, triglycerides (fats in the blood)

  • May cause low white blood cell count, which can be serious but very rare, or increased  of these



  • Shortened or lengthened duration of sleep

  • Insomnia, drowsiness

  • Having more dreams or nightmares



  • Dysphoria (mood disturbance characterized by an unpleasant and disturbing feeling of sadness, anxiety,  tension, irritability; opposite of euphoria)

  • Asthenia. Weariness, feeling tired.  Very similar to varying degrees of depressive symptoms in many people taking neuroleptics

  • Difficulty concentrating

  • Memory problems

  • Psychosis

Overdose Risks​

In case of overdose, it is advisable to contact the poison control center for medical help.


Overdose Symptoms  are usually a manifestation  excessive drug effects:

  • Drowsiness

  • Sedation, confusion

  • Dry mouth

  • Tachycardia, arrhythmia

  • Drop in blood pressure

  • Seizures

Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this field. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each drug. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.

Common and frequent withdrawal symptoms for all classes: anxiety, nervousness, restlessness, sleep problems, greater need to rest, sleep, irritability, fatigue.

Withdrawal symptoms for neuroleptics :

Withdrawal symptoms appear a few days after the dose is reduced. In the process of progressive reduction according to the method of 10  %, the last step can be particularly difficult. It can be lengthened or split to reduce withdrawal symptoms.

Main psychological withdrawal symptoms:

  • Withdrawal psychosis

  • Nervousness or restlessness

  • Insomnia

Main physical withdrawal symptoms:

  • Muscle stiffness; body aches (sore all over)

  • Tremors

  • Sweat

  • Runny nose

  • Nausea, vomiting

  • Cramps, abdominal pain

  • Diarrhea

  • Salivation

  • Headaches (headaches)

  • Nightmares

  • Palpitations

  • Hypertension

  • Discovery of tardive dyskinesia (Definition: abnormal and involuntary movements of the tongue, jaw, trunk or extremities whose appearance is related to the taking of neuroleptic drugs. tardive dyskinesia may become irreversible.)


Clozaril (clozapine) carries a higher risk with respect to withdrawal psychosis because its duration of action is short.

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