How does this medication work? What will it do for me?
Clozapine belongs to a family of medications called antipsychotics. It is used to treat schizophrenia when other medications are not effective. Schizophrenia is related to imbalances in certain brain chemicals such as dopamine. This medication helps to balance these chemicals.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each pale yellow, round, bevelled-edged tablet, with "CZ25" on one side and "G/G" (pressure sensitive bisect) on the other side, contains clozapine 25 mg. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.
Each pale yellow, round, flat bevelled-edged tablet, with "CZ50" on one side and "G/G" (pressure sensitive bisect) on the other side, contains clozapine 50 mg. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.
Each pale yellow, round, bevelled-edged tablet, with "CZ100" on one side and "G/G" (pressure sensitive bisect) on the other side, contains clozapine 100 mg. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.
Each pale yellow, oblong, normal convex tablet with "CZ200" on one side and "G/G" on the other side, contains clozapine 200 mg. Nonmedicinal ingredients: colloidal silicon dioxide, corn starch, lactose monohydrate, magnesium stearate, povidone, and talc.
How should I use this medication?
The recommended dose varies widely based on need but is usually started at 12.5 mg taken once or twice daily and adjusted gradually upwards according to the doctor's instructions.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Do not stop taking this medication without talking to your doctor. If it becomes necessary to stop this medication, the dose should be reduced gradually to prevent withdrawal effects. Stopping clozapine too quickly can cause a return of the symptoms you originally started taking the medication for as well as headache, nausea, vomiting, and diarrhea.
It is important to take this medication exactly as prescribed. If you miss a dose of this medication and remember within 2 hours, take it as soon as possible. However, if it has been more than 2 hours, skip the missed dose and go back to your regular dosing schedule. If you miss 2 or more days of clozapine doses, talk to your doctor before restarting the medication. You may need to start taking the medication at a lower dose than you were taking previously.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to clozapine or any ingredients of this medication
- are unable to undergo regular blood tests
- have active liver disease associated with nausea, loss of appetite, or jaundice (yellowing of skin)
- have certain blood disorders (e.g., platelet disorders, low white blood cells)
- have obstruction of the bowels
- have severe heart disease (e.g., myocarditis)
- have severe kidney disease
- have uncontrolled epilepsy
- have problems with drug or alcohol abuse
Do not give this medication to people who are in a severely sedated or comatose state.
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal discomfort or heartburn
- dizziness or lightheadedness (mild)
- dry mouth
- headache (mild)
- increased watering of mouth
- increased sweating
- nausea or vomiting
- stuffy nose
- trembling or shaking
- unusual weight gain
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abnormal heart rhythms (such as fast or slow heart rate, palpitations), fainting, or seizures
- blurred vision
- change in thoughts or behaviours
- decreased sexual ability
- diarrhea (severe)
- difficulty speaking
- difficulty urinating
- dizziness, especially when getting up from a lying or sitting position
- drowsiness (severe)
- hallucinations (seeing, hearing, or feeling things that are not there)
- high blood sugar (increased appetite, increased thirst, increased urination, weakness)
- infections (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- inflammation of the heart muscle
- liver problems (dark urine, decreased appetite, nausea, vomiting, yellow eyes or skin)
- muscle spasms
- muscle weakness
- problems swallowing
- puffing of cheeks
- rapid or worm-like movements of tongue
- restlessness or need to keep moving
- severe constipation with vomiting
- signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
- signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worse when breathing in, coughing, coughing up blood, sweating, or passing out)
- signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of heart problems (e.g., fast, irregular heartbeat or pulse, chest pain, sudden weight gain, difficulty breathing, leg swelling)
- signs of neuroleptic malignant syndrome (e.g., confusion, reduced consciousness, high fever, or muscle stiffness)
- signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
- signs of pneumonia (e.g., fever, chills, shortness of breath, cough)
- symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
- trouble sleeping
- trouble urinating
- uncontrolled chewing movements
- uncontrolled movements of arms and legs
- unexplained muscle pain
- unusual anxiety, nervousness, or irritability
- unusual excitement, nervousness, or restlessness
Stop taking the medication and seek immediate medical attention if any of the following occur:
- an erection that lasts more than 4 hours
- convulsions (seizures)
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, swelling of the face and throat)
- signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
- signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
- symptoms of severely increased blood pressure (e.g., chest pain, blurred vision, dizziness, excessive tiredness, headache, stronger or faster heart beat)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Blood clots: This medication may increase the chance of blood clot formation, causing reduction of blood flow to organs or the extremities.
If you have a history of clotting you may be at increased risk of experiencing blood clot-related problems such as heart attack, stroke, or clots in the deep veins of your leg. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms such as sharp pain and swelling in the leg, difficulty breathing, chest pain, blurred vision, or difficulty speaking, contact your doctor immediately.
Blood disorders: Because of the significant risk of serious blood disorders, including life-threatening decrease in white blood cell counts, clozapine should only be used by people for whom other medications do not work or for whom other medications cause intolerable side effects.
Blood work must be performed regularly (usually weekly or every 2 weeks) in order to monitor the effect of the medication on the number of white blood cells. Weekly lab tests should also continue for 4 weeks after the medication is stopped. If you notice lethargy (a tired and groggy feeling), weakness, fever, sore throat, flu-like complaints, or any other signs of infection, contact a doctor immediately.
For safety reasons, lab test results are recorded in patient registries. A patient registry is a database of health-related information collected from people with a particular medical condition for the purposes of safety and research. Different drug companies that make clozapine have different registries. If you switch from one brand of clozapine to another, your name will be entered into a different registry, and it will make it difficult to monitor your history of clozapine use and your safety. To ensure that this does not happen, new information will be added to the Patient Registration Form. This will help improve the way your health information is collected and shared between registries.
Diabetes: Clozapine may cause an increase in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.
If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Drowsiness/reduced alertness: Clozapine may affect the mental or physical abilities needed to drive or operate machinery, particularly during the first few days of taking this medication. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.
Enlarged prostate: This medication may worsen symptoms of an enlarged prostate, such as reduced urine flow. If you have a prostate condition, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Glaucoma: People with glaucoma (increased pressure in the eyes) may find that this medication makes the symptoms of glaucoma worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Heart and lung problems: Clozapine may increase the risk of heart and lung problems. If you have heart disease, you should not use this medication. Get medical attention immediately if you notice chest pain; shortness of breath; fast, irregular, or pounding heartbeat; extreme fatigue; flu-like symptoms; unexplained fever; more noticeable neck veins when standing or sitting; or fainting.
Heart rhythm: Clozapine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious, life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., if you have heart failure, angina, or low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Interruption of treatment: If you stop taking clozapine for 2 days or more, do not restart your medication at the same dosage; contact your doctor for dosage instructions.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Clozapine is broken down by the liver. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
This medication may also cause a decrease in liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Low blood pressure: Extreme lowering of blood pressure when moving from a lying or sitting to a standing position, with or without loss of consciousness, can occur with clozapine, especially at the beginning of therapy when doses are being increased. To reduce the possibility of this being problematic, rise slowly when rising from a sitting or lying position.
Movement disorder: People taking clozapine may develop tardive dyskinesia, a disorder of uncontrolled muscle movements, mainly in the face, tongue, mouth, or jaw. The risk increases with longer treatment and is higher in seniors, especially senior women. Tardive dyskinesia is more likely to be irreversible with long-term treatment (over 12 weeks). If you develop signs and symptoms of tardive dyskinesia, including sticking the tongue out, smacking the lips, pursing or puckering of lips, or other involuntary movements, contact your doctor as soon as possible.
Neuroleptic malignant syndrome: A rare but serious effect called neuroleptic malignant syndrome has been reported with antipsychotic medications such as clozapine. You should monitor for the following symptoms: altered mental status, heart palpitations, high fever, irregular pulse or blood pressure, muscle rigidity (muscle stiffness), and sweating. If you notice these symptoms, contact your doctor immediately.
Seizures: Clozapine may cause seizures. The dosing prescribed by the doctor should be carefully followed and activities requiring alertness (e.g., driving, operating machinery, swimming, climbing) should be avoided.
Pregnancy: Clozapine should be used only if the benefits clearly outweigh the risks. If you become pregnant or intend to become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are taking clozapine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and efficacy of this medication for use by children and adolescents below age 18 have not been established.
Seniors: People over the age of 60 years may have an increased risk of developing side effects from this medication. Studies with antipsychotic medications have shown that seniors with dementia taking antipsychotic medications have an increased rate of death. Seniors with dementia should not take clozapine.
What other drugs could interact with this medication?There may be an interaction between clozapine and any of the following:
- amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
- antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
- antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
- anti-Parkinson's agents (e.g., amantadine, bromocriptine, levodopa)
- antipsychotics (e.g., chlorpromazine, haloperidol, olanzapine, quetiapine, risperidone)
- "azole" antifungals (e.g., fluconazole, ketoconazole, voriconazole)
- barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
- benzodiazepines (e.g., clonazepam, diazepam, lorazepam)
- botulinum toxin
- chloral hydrate
- corticosteroids (e.g., budesonide, dexamethasone, hydrocortisone, fluticasone, prednisone)
- diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
- ergot alkaloids (e.g., ergotamine, dihydroergotamine)
- ethinyl estradiol
- general anaesthetics (medications used to put people to sleep before surgery)
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- magnesium sulfate
- medications that can suppress the immune system (e.g., azathioprine, biologics, cancer medications, cyclosporine, hydroxyurea, mycophenolate, tacrolimus)
- monoamine oxidase inhibitors (MAOIs; moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
- narcotics (e.g., codeine, fentanyl, morphine, oxycodone)
- potassium chloride
- quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
- St. John's wort
- serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
- serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
- seizure medications (e.g., carbamazepine, clobazam, felbamate, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine)
- some beta-adrenergic blockers (e.g., carvedilol, metoprolol, propranolol, timolol)
- thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
- tobacco smoke
- tricyclic antidepressants (e.g.,amitriptyline, clomipramine, desipramine, trimipramine)
- "triptan" migraine medications (e.g., eletriptan, sumatriptan)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.