Sizopin 25

• Schizophrenia (in patients unresponsive to or intolerant of conventional antipsychotic drugs)
• Psychosis in Parkinson's disease

Clozapine is classified as an 'atypical' antipsychotic drug because of its profile of binding to dopamine receptors and its effects on various dopamine-mediated behaviors differ from those exhibited by other typical antipsychotic drug products. In particular, although Clozapine does interfere with the binding of dopamine at D1, D2, D3 and D5 receptors, and has a high affinity for the D4 receptor. This evidence, consistent with the view that Clozapine is preferentially more active at limbic than at striatal dopamine receptors. This may explain the relative freedom of Clozapine from extrapyramidal side effects. Clozapine also acts as an antagonist at adrenergic, cholinergic, histaminergic and serotonergic receptors.

Adult Dose (Schizophrenia - Oral): Initial: 12.5 mg once or twice daily; Day 2: 25-50 mg; increase by 25-50 mg daily (if well tolerated) to 300-450 mg/day by 2 weeks; may increase to 600-900 mg/day if needed. Maintenance: Continue effective dose.

Adult Dose (Psychosis in Parkinson's disease): Initial: 12.5 mg at night; increase by 12.5 mg up to twice weekly based on response; usual dose: 25-37.5 mg at night; max: 100 mg/day in 1-2 divided doses.

Elderly: Lower initial dose of 12.5-25 mg/day; titrate more slowly.

Renal Dose: Severe renal impairment: Contraindicated (CrCl <10 mL/min).

Common Side Effects:

• Increased sweating
• Visual impairment
• Decreased blood pressure
• Constipation
• Dizziness or lightheadedness
• Drowsiness
• Headache
• Increased watering of mouth
• Nausea or vomiting
• Unusual weight gain

Serious Side Effects: Agranulocytosis (life-threatening), myocarditis, seizures, neuroleptic malignant syndrome, hyperglycemia, orthostatic hypotension.

[SAFE IF PRESCRIBED] Clozapine is generally considered safe to use during pregnancy. Animal studies have shown low or no adverse effects to the developing baby; however, there are limited human studies. Pregnancy Category B.

• [UNSAFE] Clozapine may cause side effects which could affect your ability to drive. You may feel tired, drowsy, dizzy or faint, especially during early treatment.
• Do not stop abruptly (taper over 1-2 weeks).
• WBC monitoring: Weekly for first 6 months, then every other week.
• Inform your doctor immediately if you notice signs of infection (fever, sore throat, rash).
• May cause dizziness and sleepiness; avoid driving or activities requiring concentration.
• Monitor weight, blood sugar and cholesterol.
• Caution during pregnancy and contraindicated during lactation.

Overdose symptoms: Altered states of consciousness (drowsiness, delirium, coma), tachycardia, hypotension, respiratory depression/failure, hypersalivation, aspiration pneumonia, cardiac arrhythmias, seizures. Treatment: Establish and maintain airway; ensure adequate oxygenation and ventilation; activated charcoal; cardiac and vital signs monitoring; general symptomatic and supportive measures. Avoid epinephrine and derivatives; avoid quinidine and procainamide. No specific antidotes.

Do not store above 30°C. Keep away from light and out of reach of children.