Overview
Clozaril is the brand name for Clozapine, a phenothiazine. Clozaril is an atypical antipsychotic drug that helps to correct an imbalance of nerve impulses that causes schizophrenic thought disorders.

Clozaril’s effects can usually be felt within two to four weeks.

Why is this drug prescribed?
Clozaril is used to treat schizophrenia and false perceptions such as hallucinations or delusions.

Clozaril is often prescribed for people whose negative or positive symptoms have not improved after treatment with at least two other antipsychotic drugs, or who encountered unusually severe side effects from taking other antipsychotic medications. Clozaril improves symptoms in 50-60% of patients who are not helped by other antipsychotic medications.

Warnings and Precautions
Because safety and effectiveness of Clozaril in children under 16 years old has not been established, this drug is not recommended for children under 16.

Patients taking Clozaril must have blood tests done every week for at least the first six months of therapy. Only 7 to 14 days of medication are dispensed at one time, and only if blood tests indicate that it is safe to continue Clozaril therapy.

Clozaril can cause drowsiness and loss of coordination, especially at the beginning of therapy. Patients should not drive or operate heavy machinery until they know that Clozaril does not impair the ability to safely engage in these activities.

For Pregnant or Nursing Mothers: Animal studies indicate no significant risk to the fetus when Clozaril is taken during pregnancy, but little information is available concerning Clozaril and human pregnancy; pregnant women are advised not to take this drug. Clozaril is passed into breast milk, nursing while taking Clozaril is not advised.

Contraindications
Clozaril should Not be used for people with the following medical conditions:

1. myeloproliferative ( bone marrow and white blood cell disorder)
2. a history of drug-induced agranulocytosis or severe granulocytopenia (low white blood cell count)
3. severe central nervous system depression
4. comatose states
5. severe liver or kidney disease
6. severe heart disease
7. epilepsy that is not controlled
8. taking another medication that lowers white blood cell count

Clozaril may be given with caution to people with the following conditions:

1. elderly – may require a lower dosage, more sensitive to side effects
2. epilepsy (controlled)
3. blood disorder such as anemia
4. special diet such as low-salt or low-sugar
5. heart disease or arrhythmias

Adverse Reactions
Clozaril may cause the following reactions:

1. dizziness
2. drowsiness / sedation
3. rapid heartbeat
4. low blood pressure
5. fainting
6. excessive salivation
7. constipation
8. headache
9. fever
10. agitation / restlessness
11. tremor
12. sleep disturbances / nightmares
13. confusion
14. sweating
15. dry mouth
16. sore throat
17. high blood pressure
18. nausea / vomiting
19. abdominal discomfort
20. reduced white-blood-cell count (agranulocytosis)
21. seizures
22. visual changes
23. weight gain
24. reduced urinary output

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Clozaril are:

1. drugs that lowers blood pressure, such as: Amantadine (Symmetrel), antihypertensives (high blood pressure medicine), antipsychotics (medicine for mental illness), Bromocriptine (Parlodel), certain eye drops used to treat glaucoma (carteolol [Ocupress], levobunolol [Betagan], metipranolol [OptiPranolol], timolol [Timoptic]), diuretics (water pills), levodopa (Dopar), medicine for heart disease, Nabilone (Cesamet) (with high doses), narcotic pain medicine, Pentamidine (Pentam), Pimozide (Orap), Promethazine (Phenergan), Trimeprazine (Temaril) – can increase Clozaril’s side effect of lowering blood pressure
2. Alcohol and other nervous-system depressants, including benzodiazepines and other antianxiety drugs - can increase Clozaril’s sedative effects
3. Lithium – taken with Clozaril could cause seizures and/or confusion
4. tobacco smoking – can increase the elimination of Clozaril from the body and increase the dosage required
5. agents that suppress bone marrow function
6. MAO Inhibitors – Clozaril can increase the effects of these drugs
7. epinephrine
8. drugs which are highly bound to protein (such as warfarin, digitoxin)

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