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
- 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
- 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.