Published: Feb. 21, 2019, 3:07 p.m.
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.