{"id":3856,"date":"2025-03-31T18:11:51","date_gmt":"2025-03-31T18:11:51","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/clozapine-txt\/"},"modified":"2025-03-31T18:11:51","modified_gmt":"2025-03-31T18:11:51","slug":"clozapine-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/clozapine-txt\/","title":{"rendered":"Clozapine.txt"},"content":{"rendered":"<h1>Clozapine<\/h1>\n<p><H3>  CLINICAL USE <\/H3><br \/>\nAtypical antipsychotic:Schizophrenia Psychosis in Parkinson\u2019s disease <H3> DOSE IN NORMAL RENAL FUNCTION  <\/H3>Schizophrenia: 200\u2013450 mg daily in  divided doses, maximum 900 mg dailyPsychosis in Parkinson\u2019s disease: 25\u2013 37.5 mg daily at night, maximum 100 mg daily in 1\u20132 divided doses<H3>  PHARMACOKINETICS    <\/H3><LI> Molecular weight &amp;nbsp  &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp  &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp :326.8<\/li>\n<li>  %Protein binding  &amp;nbsp &amp;nbsp &amp;nbsp  &amp;nbsp  &amp;nbsp  &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp :95\u201397<\/li>\n<li>  %Excreted unchanged in urine &amp;nbsp &amp;nbsp : Minimal (50% as metabolites)<\/li>\n<p><LI> Volume of distribution (L\/kg) &amp;nbsp &amp;nbsp &amp;nbsp :1.6\u20136<\/li>\n<p><LI>half-life \u2013 normal\/ESRD (hrs)&amp;nbsp &amp;nbsp &amp;nbsp :6\u201326<H3>  DOSE IN RENAL IMPAIRMENT <\/H3> <H4>GFR (mL\/MIN)<\/H4><LI> 20 to 50  &amp;nbsp &amp;nbsp : Dose as in normal renal function; use with caution<LI> 10 to 20  &amp;nbsp &amp;nbsp : Dose as in normal renal function; use with caution<LI> &lt;10 &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp : Start with a low dose and titrate slowly<H3> DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES  <\/H3><LI> CAPD  &amp;nbsp &amp;nbsp &amp;nbsp  &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp:Unlikely to be dialysed. Dose as in GFR &lt;10 mL\/min<\/p>\n<li> HD &amp;nbsp  &amp;nbsp &amp;nbsp  &amp;nbsp &amp;nbsp  &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp &amp;nbsp :Unlikely to be dialysed. Dose as in GFR &lt;10 mL\/min<LI>HDF\/high flux  &amp;nbsp :Unknown dialysability. Dose as in GFR &lt;10 mL\/min<LI>CAV\/VVHD  &amp;nbsp &amp;nbsp &amp;nbsp:Unknown dialysability. Dose as in GFR 10 to 20   mL\/min <H3> IMPORTANT DRUG INTERACTIONS  <\/H3>Potentially hazardous interactions with other drugsAnaesthetics: enhanced hypotensive effect Analgesics: avoid concomitant use  with azapropazone; increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioidsAnti-arrhythmics: increased risk of  ventricular arrhythmias with anti-arrhythmics that prolong the QT interval; increased risk of arrhythmias with flecainideAntibacterials: concentration possibly  increased by erythromycin (possible increased risk of convulsions); concentration increased by ciprofloxacin; concentration possibly reduced by rifampicin; avoid concomitant use with chloramphenicol and sulphonamides (increased risk of agranulocytosis)Antidepressants: concentration possibly  increased by citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and venlafaxine (increased risk of toxicity); possibly increased CNS effects of MAOIs; possibly increased antimuscarinic effects with tricyclics; increased plasma level of tricyclicsAnti-epileptics: antagonises anticonvulsant  effect; metabolism accelerated by carbamazepine and phenytoin; avoid concomitant use with drugs known to cause agranulocytosisAntimalarials: avoid concomitant use with  artemether\/lumefantrineAntipsychotics: avoid concomitant use  with depot formulations (cannot be withdrawn quickly if neutropenia occurs)Antivirals: concentration possibly  increased by amprenavir; concentration increased by ritonavir \u2013 avoid concomitant useAnxiolytics and hypnotics: increased  sedative effectsCytotoxics: increased risk of  agranulocytosis \u2013 avoid concomitant useLithium: increased risk of extrapyramidal  side effects and possibly neurotoxicityPenicillamine: increased risk of  agranulocytosis \u2013avoid concomitant useSibutramine: increased risk of CNS  toxicity \u2013 avoid concomitant use Ulcer-healing drugs: effects possibly  enhanced by cimetidine; concentration possibly reduced by omeprazole.<H3> ADMINISTRATION  <\/H3><H4> Reconstition<\/H4>\u2013<H4>  Route  <\/H4>Oral <H4>  Rate of Administration  <\/H4>\u2013<H4>Comments<\/H4>\u2013<H4>  OTHER INFORMATION  <\/H4>Patient must be registered with  appropriate company monitoring schemeAssociated with myocarditis (increased  risk in the first 2 months) and cardiomyopathyPotentially fatal agranulocytosis and  neutropenia have been reported. WCC has to be monitored at least weekly for the first 18 weeks then 2 weekly for weeks 18\u201352 and then at least 4 weeklyIncreased risk of side effects especially  seizures in doses above 450 mg dailyRarely interstitial nephritis has been  reported with clozapineDose in severe renal impairment taken  from personal experience.<br \/>\n","protected":false},"excerpt":{"rendered":"<p>Clozapine CLINICAL USE Atypical antipsychotic:Schizophrenia Psychosis in Parkinson\u2019s disease DOSE<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-3856","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3856","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=3856"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3856\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=3856"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=3856"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=3856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}