Clozapine(clozapil®)

Clozapine, olanzapine, risperidone and quetiapine are part of a group of drugs called atypical antipsychotic. Although, they are not specifically drugs for Alzheimer’s dementia they could be useful. They are used to control behaviour, orientate speech and thoughts and organise hallucinations or delusions

The way these drugs work is extremely complicated and not well understood. They block many messengers that communicate between the neurons in the brain, such as dopamine, histamine, and acetylcholine

Clozapine has been proven to control symptoms such as apathy and social isolation and also create better response that many other antipsychotic’s

Due to its complicated and broad spectrum of blocking they produce a great variety of side effects. Side effects tend to be more common and noticeable with high dosage than low, which are often more recommended. The most common side effects are:
• dizziness
• weight gain
• hypertension when patient change posture, such as standing from seating (specially during initial dose titration)
• faster beating of the heart
• in some patients extrapyramidal side effects occur (usually mild and transient). Extrapyramidal side effects are a group of side effects characteristic to antipsychotic drugs. They include: restlessness (patients pace up and down, constantly shift their leg position or tap their feet); sustained muscle contraction, grimacing facial distortion, neck twisting and laboured breathing; occasionally, fixed staring, eyeballs move upwards and then sideways, remarking in that position; mouth wide open tongue protruding and the head tilting backwards; and Parkinsonism side effects like tremor, rigidity and poverty of facial expression
• hormonal effects, such as secretion of milk from the breast, missed periods and loss of libido
• decrease number of cells in the blood, especially blood cells that protect the body again infections.
• create toxicity on the cells of the heart and on the heart itself

There will be a list of other less common side effects in the leaflet given with your medication

This great profile of side effects, especially the last two, has made the drug available for inbase patient prescribing, where the patients have to get register with the drug company to obtain the supply through a pharmacy

Before starting the medication a medical examination for cardiac abnormalities or history of heart disease has to be done by cardiac specialist. Blood test have to be done before starting medication; every week for the first 18 weeks and then every 2 weeks for the first year and afterward every 4 weeks as long as the medications is prescribed. Before every supply, tests have to be successful to obtain the medication

They should never been prescribed in breast feeding women

If another medication is required, please don’t forget to check with the pharmacist

Reproduced with kind permission of Maria Sanchez our Consultant Pharmacist