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Psychopharmacology and Psychiatry Updates

Mar 8, 2019

Today’s question is: How to manage the non-hematological adverse effects of clozapine?

Here is a summary of this episode:

  • Clozapine can commonly cause a benign fever. If a patient is feverish, do a workup to exclude infections, myocarditis, NMS and inflammatory conditions.
  • For orthostatic hypotension, slowly titrate, encourage fluid intake and avoid other alpha 1 blockers and benzodiazepines. You can consider using 9-fludrocortisone for volume expansion.
  • In cases of tachycardia, manage orthostasis first and if it persists, use atenolol. Keep the resting heart rate under 100 beats per minute.
  • If you suspect myocarditis, measure troponin, and CRP levels. If positive, stop clozapine and cover with an anticholinergic.
  • For the metabolic effects of clozapine, behavioral control techniques are worth a try. You can also start metformin concurrently with clozapine as an effective and safe option.