Clozapine is used to treat schizophrenia (long-term mental disorder that causes changes in thoughts, feelings, and behaviour) for whom other medicines have not worked or have caused severe side effects. It helps relieve symptoms common in schizophrenia, such as distorted thinking and emotional instability. It also helps to reduce the risk of suicidal behaviour in schizophrenia.
This medicine is also used to treat severe mood disturbances in individuals with Parkinson's disease (a disorder that affects the movement of a person, causing symptoms such as tremors, muscle stiffness, slowed movement and impaired balance or walking).
Take Clozapine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
You may take this medicine with or without food. Try to take it at the same time each day.
Clozapine is available as a conventional tablet, oral disintegrating tablet, and as oral suspension.
If you have been given the oral disintegrating tablet, remove it from the foil only just before you take it. Place the tablet on your tongue and chew or allow it to dissolve. Then, swallow it with your saliva. If you are taking only part of the tablet, throw away the part that is not taken.
If you are taking the oral suspension, shake the bottle well before you take the medicine to ensure that the liquid is evenly mixed. Use the syringe adapter supplied with each bottle to measure your dose.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and your response to the medication.
Clozapine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it suddenly as this may worsen your condition.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Alert your doctor if you have the following conditions:
- history of blood disorders that cause a very low white blood cell count called agranulocytosis or granulocytopenia
- impaired bone marrow function
- uncontrolled epilepsy (fits or seizures)
- severe heart disease e.g. myocarditis (an inflammation of the heart muscle)
- CNS depression (a condition that causes drowsiness or affects your concentration)
- paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
- mental illness caused by alcohol or drug addiction
- liver disease or failure
- severe kidney disease
as Clozapine may not be suitable for you.
Do not take Clozapine with certain preparations of medicines used to treat mood disorders called long-acting depot antipsychotics, and certain medicines that affect or stop your bone marrow from working properly. Please see the section "Can I take this with other medicines?" below for more information.
Inform your doctor if you have the following conditions:
- heart disease
- family history of heart rhythm disorder
- disease of the blood vessels supplying the brain
- at risk of stroke
- history of epilepsy (fits or seizures)
- decreased bowel activity
- urinary retention (inability to completely empty the bladder when urinating)
- visual problems
- diabetes
- mild to moderate kidney disease
This medicine is not approved for the treatment of individuals with mood disorders related to dementia (a group of symptoms affecting thinking, memory, and social abilities).
Let your doctor know if you are pregnant or breastfeeding.
Be sure to check with your doctor or pharmacist before giving Clozapine to the elderly. Elderly people may be more sensitive to the side effects.
Notify your doctor if you are a smoker.
Medicines for depression such as Clozapine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts, or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
Some genetic traits can affect the level of Clozapine in the blood. A certain enzyme called CYP2D6 is involved in the breakdown of this medicine in the body. Individuals who are poor metabolisers of CYP2D6 may experience enhanced effects of this medicine. If you know you have this gene type, inform your doctor.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Routine tests (e.g. complete blood count, liver or kidney function, blood cholesterol, sugar, and electrolyte levels) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
- Your blood pressure may rise or fall to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
- Regular monitoring for any signs of infection (e.g. fever, sore throat) may also be needed.
What lifestyle changes should I make?
Clozapine may affect the ability of your body to adjust to temperature changes in the environment. Avoid exposure to very cold or very hot environments. Avoid strenuous exercise and activities like going to the sauna. Drink more water to prevent dehydration.
Clozapine may cause drowsiness. If affected, do not drive or take part in any activity in which you need to be alert.
This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Clozapine also reduces the ability of your body to sweat. Avoid exposure to excessive sunlight or exercise which may cause your body to overheat as you are not able to sweat. Increase your fluid intake and stay in a cool environment.
Other side effects include any of the following: dizziness, headache, nausea, vomiting, indigestion, dry mouth, rash, increased sweating, big weight gain and loss of appetite.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- signs and symptoms of heart problem e.g. chest pain, tightness or pressure, pain that may spread to the arms, jaw, neck, shoulder or back, shortness of breath, lightheadedness
- signs and symptoms of lung problem e.g. shortness of breath, chest pain, cough which may contain blood
- pain, swelling and tenderness in your leg accompanied by redness and warmth
- yellowing of the skin or eyes, abdominal pain, dark coloured urine, tiredness, swelling in the legs and ankles
- fever, muscle cramps or stiffness, severe headache, fast heartbeat, excessive sweating
- very severe constipation or stomach pain, trouble passing gas, bloatedness
- weakness or numbness on one side of the body, trouble speaking, vision problems, changes in balance or coordination
- thirst, increased urination, fruity breath odour
- having thoughts of self-harm
- dry mouth, difficulty passing urine, constipation
- fits or seizures
- tremors, slowed movements, stiffness of the arms and legs, imbalance while walking, and other uncontrollable movements such as twitching and jerking
Clozapine may cause the level of your white blood cells.
White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, cough, or flu that does not go away.
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not take Clozapine with the following medicines:
- certain preparations of medicines used to treat mood disorders called long-acting depot antipsychotics
- certain medicines that affect or stop your bone marrow from working properly e.g. carbamazepine, chloramphenicol, cotrimoxazole
Inform your doctor and pharmacist if you are taking any of these medicines:
- medicines used to treat depression e.g. fluvoxamine, fluoxetine, sertraline
- medicines for mood disorders e.g. lithium, perazine
- medicines for high blood pressure
- medicines that cause drowsiness or affect your concentration
- strong painkillers
- digoxin (medicine for heart failure [weakness and inability of the heart to pump blood])
- phenytoin (medicine for fits or seizures)
- warfarin (blood-thinning medicine)
- ciprofloxacin (certain antibiotic)
- omeprazole (medicine that reduces stomach acid production)
- birth control pills
This list does not include all medicines that may interact with Clozapine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.
Avoid alcohol. Alcohol intake may worsen the drowsiness caused by Clozapine.
Store in a cool, dry place away from the reach of children.
Protect the orodispersible tablet from moisture.
The oral suspension can be stored at room temperature not exceeding 25°C after you have mixed the powder with water. Do not refrigerate or freeze, otherwise it will become less effective. Throw away unused portion after 100 days.
Medicines must not be used past the expiry date.
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