Has your doctor prescribed you or a loved one a medication called Clozapine? If so, it is important to talk about this medication in some detail. Because this is not like a regular medication, it requires a little special attention, and it is a very effective treatment. Let's talk about everything simply and clearly.
What kind of medicine is this Clozapine?
Simply put, Clozapine is a medication used to treat mental illnesses such as schizophrenia . However, it is not the first choice for everyone. Doctors usually prescribe this medication when other treatments have not worked as well as expected, or when the side effects of other medications are intolerable.
This belongs to the group of drugs called 'Antipsychotic' . This medicine mainly works by balancing the activity of chemicals like Dopamine and Serotonin, which help in nerve communication in our brain. Through this, it stabilizes the mind and controls the symptoms.
Things you need to tell your doctor before starting medication
Before your doctor prescribes this medicine, he or she will need to have a complete picture of your health. Therefore, if you have any of the following conditions, be sure to tell your doctor about them.
- If you have ever had an allergic reaction to Clozapine or any other medicine, food, or dye.
- If you have diabetes or if someone in your family has it.
- If you have conditions such as heart disease , high cholesterol, high/low blood pressure, or irregular heartbeat.
- If you have previously had a stroke .
- If you have any liver or kidney disease.
- If you have a medical condition such as low blood counts , low white blood cells, low red blood cells, or low platelets.
- If you frequently experience constipation or have a blockage in your intestines.
- If you have seizures or convulsions.
- If you have Parkinson's disease .
- If you have a memory disorder such as dementia.
- If you have a prostate problem or difficulty urinating.
- If you have the eye disease glaucoma.
- If you have difficulty swallowing something.
- If you are a smoker. (This is very important, we will talk about it later).
- If you are pregnant, trying to get pregnant, or breastfeeding.
If anything on this list applies to you, don't hide it from your doctor. It's very important for your safety.
How exactly do I use this medicine?
- Take the dose prescribed by your doctor, exactly as prescribed, and at the right time. Swallow the tablet with a glass of water.
- It doesn't matter if you take it before or after meals.
- Do not take more than the doctor tells you to, or take it earlier than the prescribed time.
- Most importantly: Do not stop taking this medication suddenly for any reason without medical advice. Doing so may cause serious side effects. If you need to stop taking the medication, do so gradually, reducing the dosage, and only under the supervision of a doctor.
What if I take too much medicine?
If you think you have taken more than the prescribed dose of medicine, immediately call the National Poisons Information Centre at the Colombo National Hospital . Or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
What to do if you miss a dose of medicine?
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your next dose at the scheduled time. Never take a double dose to make up for a missed dose.
Special Warning: If you are unable to take your medicine for more than two days (48 hours), do not start again at the same dose. Be sure to call your doctor for advice.
Other things that can cause problems with this medicine
Clozapine is a drug that can interact with other drugs, foods, and things. So you should tell your doctor about all the medications you are taking (including vitamins and herbal remedies).
| Substance/drug category | Examples and simple descriptions |
|---|---|
| Things you should never take | |
| Some medications | Medicines such as Cisapride, Pimozide, Thioridazine. Your doctor will inform you about this. |
| Things that can cause problems and should be taken under medical advice | |
| Alcohol | Avoid drinking alcohol while taking this medicine. It can increase drowsiness and dizziness. |
| Caffeine | Caffeine, found in coffee, tea, and some soft drinks, can affect clozapine levels. Tell your doctor about the amount you are taking. |
| Smoking | Smoking can lower the level of clozapine in your blood. If you smoke or are thinking about quitting, be sure to tell your doctor. Your dose may need to be adjusted. |
| Other medications | Some medications for colds, allergies, depression, insomnia, epilepsy, fungal infections, and high blood pressure may interact with this. |
Things to be especially careful about while taking the medicine
Be aware of these things to ensure your safety when taking clozapine.
Compulsory Blood Tests
This is the most important thing. When you start taking clozapine, you should have a blood test once a week for the first few weeks. This is to check the number of white blood cells in your blood. Sometimes this medicine can cause your white blood cell count to drop dangerously low. This can make it harder for you to fight off infections. If your blood counts are good after about 6 months, your doctor will likely recommend that you have this test every two weeks.
Drowsiness and dizziness
This medicine may make you feel drowsy and dizzy. Therefore, avoid activities that require alertness, such as driving or operating machinery, until you know how this medicine affects you. Do not stand or sit up suddenly.
Constipation
Constipation is common with this medication, but it can be serious. If you do not have a bowel movement after 2-3 days, or if you experience symptoms such as bloating, stomach pain, or nausea, call your doctor immediately. Drink plenty of water.
Body temperature control
This medicine may reduce your ability to tolerate extreme cold and heat. Therefore, dress appropriately in cold weather. Minimize sun exposure and exertion in hot weather. Drink plenty of water.
Possible side effects of the medicine
Like all medications, this one can have side effects. Some of them are serious, some of them are common.
| Serious side effects that should be reported to your doctor or ETU immediately | |
|---|---|
| Signs of infection | Fever, chills, sore throat, mouth sores (these may be signs of low white blood cell count). |
| Heart symptoms | Chest pain, difficulty breathing, fast or irregular heartbeat, swelling of the legs. |
| Severe constipation | Severe stomach pain, bloating, vomiting. |
| Seizures | If the body shakes uncontrollably. |
| NMS characteristics | High fever, muscle stiffness, excessive sweating, and confusion. (Neuroleptic Malignant Syndrome) |
| Allergies | Skin rash, itching, swelling of the face, lips, tongue. |
| Usually not serious, but tell your doctor if it persists. | |
| Excessive salivation | This can happen especially at night. |
| Drowsiness, dizziness | This may decrease as the body adjusts to the medication. |
| Weight gain | Talk to your doctor about diet and exercise. |
| Headache | May occur slightly. |
Take-Home Message
- Clozapine is a very effective treatment for mental illnesses that have not responded to other medications, but it must be taken under strict medical supervision.
- Never stop taking medication or change the dosage without medical advice.
- Weekly or biweekly blood tests are essential for your safety. Don't skip them.
- Tell your doctor about all other medications you take, whether or not you smoke, and all of your medical conditions.
- Seek immediate medical attention if you develop warning signs such as fever and sore throat, severe chest pain, or severe constipation.
- If you miss more than two days of medication, talk to your doctor before starting again.
👩🏽⚕️ Additional questions (FAQs)
💬 Clozapine (Clozaril) tablets are the last resort for which disease?
This is the first new generation (Atypical) extremely powerful drug developed to control the severe mental illness called 'Schizophrenia'! This is not given to everyone, it is used only for the most difficult patients (Treatment-resistant) and Suicidal/Aggressive patients, who do not seem to be able to hear the strange voices of the patient despite all other medications.
💬 What is special about this (Clozapine) that makes it more effective than all other drugs?
Other psychiatric medications block the dopamine (D2) receptors in the brain. Then the patient becomes rigid like a robot. But this Clozapine blocks the dopamine D2 receptors very little, instead it blocks the serotonin (5HT2A) and other D4 receptors in the brain very strongly. That is why as the disease improves, it does not have that rigid side effect (EPS) at all!
💬 Why is it essential to check the white blood cells of people taking this pill (Clozapine)?
This is the most dangerous and deadly danger of this medicine! (Black Box Warning). When taking this, some patients' 'white blood cells (Neutrophils)' that fight diseases in their bodies can be destroyed 100% and completely reduced to zero (Agranulocytosis)! Then even a small cold virus can kill the patient. Therefore, 'weekly blood tests (ANC)' must be done for the entire six months of taking this medicine!
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