Clozapine
| Drug monograph · NCLEX study reference | |
| Trade names | Clozaril |
|---|---|
| Therapeutic class | Antipsychotic |
| Pharmacologic class | Second-generation antipsychotic (reserved) |
| Onset / peak / duration | Effect over weeks. |
| Half-life / level | Half-life about 12 hours; level sometimes monitored. |
| Routes | PO (oral) |
| High-alert (ISMP) | No |
| Black box warning | Yes (see Safety) |
| Antidote / reversal | Supportive care; hold for low neutrophil count. |
| Pregnancy / lactation | Use only if clearly needed. |
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Clozapine (brand name Clozaril) — Antipsychotic; Second-generation antipsychotic (reserved).
Identification
- Therapeutic class: Antipsychotic.
- Pharmacologic class: Second-generation antipsychotic (reserved).
Pharmacology
- Mechanism of action: Broad dopamine and serotonin blockade; effective in treatment-resistant schizophrenia.
- Onset / peak / duration: Effect over weeks.
- Half-life / therapeutic level: Half-life about 12 hours; level sometimes monitored.
Clinical use
- Indications: Treatment-resistant schizophrenia, reducing suicidality in schizophrenia.
- Usual dose, route, frequency: PO titrated slowly.
- Maximum dose / adjustments: Enrolled in a REMS program with mandatory blood count monitoring.
Safety
- Contraindications: Severe neutropenia, uncontrolled seizures, history of clozapine-induced agranulocytosis.
- Black box warning: Severe neutropenia and agranulocytosis (requires absolute neutrophil count monitoring), seizures, myocarditis, orthostatic hypotension with syncope, and increased mortality in elderly dementia patients.
- Interactions: Bone marrow suppressants, CNS depressants, CYP1A2 (smoking lowers levels), anticholinergics (severe constipation).
- Pregnancy / lactation: Use only if clearly needed.
- High-alert: No.
Adverse effects
- Common side effects: Sedation, hypersalivation, weight gain, constipation, dizziness.
- Serious effects to report: Fever or infection (neutropenia), chest pain (myocarditis), severe constipation or ileus, seizures.
- Antidote / reversal: Supportive care; hold for low neutrophil count.
Nursing process
- Assessment before administration: Baseline and ongoing ANC, cardiac and bowel status.
- Interventions during therapy: Verify ANC per REMS before dispensing; monitor for infection and bowel function.
- Monitor: ANC on the required schedule, cardiac signs, bowel function, metabolic labs.
- Evaluation / expected outcome: Reduced resistant psychotic symptoms.
Patient teaching
- Patient teaching: Blood draws are mandatory; report fever, sore throat, chest pain, or constipation.
- Notify provider if: Fever, sore throat, chest pain, severe constipation, fainting.
- Administration tips: Only with confirmed acceptable ANC; titrate slowly.