How to Manage Adverse Effects of Clozapine – Part 2
Today’s question is: How to manage the non-hematological adverse effects of clozapine? Here is a summary of this episode: Clozapine can commonly cause a benign fever. If a patient is feverish, do a workup to exclude infections, myocarditis, NMS and inflammatory conditions. For orthostatic hypotension, slowly titrate, encourage fluid intake and avoid other alpha 1 blockers and benzodiazepines. You can consider using 9-fludrocortisone for volume expansion. In cases of tachycardia, manage orthostasis first and if it persists, use atenolol. Keep the resting heart rate under 100 beats per minute. If you suspect myocarditis, measure troponin, and CRP levels. If positive, stop clozapine and cover with an anticholinergic. For the metabolic effects of clozapine, behavioral control techniques are worth a try. You can also start metformin concurrently with clozapine as an effective and safe option. Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute
