How to Manage Adverse Effects of Clozapine – Part 1
Today’s question is: How to manage the non-hematological adverse effects of clozapine? Here is a summary of this episode: For sialorrhea start with local agents like sublingual atropine drops or mouth ipratropium spray. If that fails, systemic agents like glycopyrrolate or terazosin can be used. For constipation, bulk agents can make constipation worse and should be avoided. After docusate, the next agent to add is PEG 3350 and then a stimulant and then lastly, if needed, lubiprostone. For sedation, titrate clozapine slowly, use bedtime dosing and reduce other sedating medications. A trial with modafinil or methylphenidate can be attempted, but the evidence is not strong. Tonic-clonic and myoclonic seizures can occur with clozapine. Titrate down and divide into multiple doses. Divalproex is the drug of choice in preventing clozapine-induced seizures. Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute
