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.
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.