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.
Practical psychopharmacology updates for mental health clinicians. Useful for psychiatry / mental health professionals. Expert interviews and soundbites from lectures. Practical and free of commercial bias. Not sponsored by any pharmaceutical company.