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Psychopharmacology and Psychiatry Updates

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, lubiprostone.
  • 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 strong.
  • 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.