Feb 21, 2019
Today’s question is: How to manage the non-hematological adverse
effects of clozapine?
Here is a summary of this episode:
- For sialorrhea start with local agents like sublingual atropine
drops or mouth ipratropium spray. If that fails, systemic agents
like glycopyrrolate or terazosin can be used.
- For constipation, bulk agents can make constipation worse and
should be avoided. After docusate, the next agent to add is PEG
3350 and then a stimulant and then lastly, if needed,
- For sedation, titrate clozapine slowly, use bedtime dosing and
reduce other sedating medications. A trial with modafinil or
methylphenidate can be attempted, but the evidence is not
- Tonic-clonic and myoclonic seizures can occur with clozapine.
Titrate down and divide into multiple doses. Divalproex is the drug
of choice in preventing clozapine-induced seizures.