Nursing Path
CARING is the essence of NURSING. -Jean Watson
Nursing Path
Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee
Nursing Path
Treat the patient as a whole, not just the hole in the patient.
Nursing Path
Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill
Nursing Path
A problem is a chance for you to do your best. -Duke Ellington
Clozapine
Generic Name : clozapine
Brand Name: Clozaril, FazaClo,
Gen-Clozapine (CAN)
Classification: Antipsychotic (Dopaminergic
blocker)
Pregnancy Category B
Dosage
& Route
Adults
§
Initial therapy: 12.5 mg PO once or twice daily.
If using orally disintegrating tablets, begin with 1/2 (12.5 mg) of a 25-mg
tablet and destroy the remaining half. Continue to 25 mg PO daily or bid; then
gradually increase with daily increments of 25–50 mg/day, if tolerated, to a
dose of 300–450 mg/day by the end of second week. Adjust later dosage no more
often than twice weekly in increments < 100 mg. Do not exceed 900 mg/day.
§
Maintenance: Maintain at the lowest effective
dose for remission of symptoms.
§
Discontinuation of therapy: Gradual reduction over a
2-wk period is preferred. If abrupt discontinuation is required, carefully
monitor patient for signs of acute psychotic symptoms.
§
Reinitiation of treatment: Follow initial dosage
guidelines, use extreme care; increased risk of severe adverse effects with
re-exposure.
Pediatric Patients
§
Safety and efficacy in patients < 16 yr not established.
Therapeutic actions
§
Clozapine has relatively weak dopamine receptor-blocking
activity at D1, D2,
D3 and D5receptors but has
high affinity for the D4 receptor. It has also blocking effects on serotonin,
α-adrenergic histamine H1 and
cholinergic receptors.
Indications
§
Management of severely ill schizophrenics who are unresponsive
to standard antipsychotic drugs
§
Reduction of the risk of recurrent suicidal behavior in patients
with schizophrenia or schizoaffective disorder (not orally disintegrating
tablet)
Adverse effects
§
Drowsiness, dizziness, headache; nausea, vomiting, constipation;
anxiety, confusion, fatigue, transient fever. Rarely, dysphagia, acute
pancreatitis, cholestatic jaundice; orthostatic hypotension, tachycardia;
seizures; hypersalivation.
§
Potentially Fatal: Rarely, thromboembolism.
Reversible neutropenia which may progress to a potentially fatal
agranulocytosis. Fatal myocarditis.
Contraindications
§
History of bone marrow disorders including agranulocytosis,
circulatory collapse, alcoholic or toxic psychosis, drug intoxication,
uncontrolled epilepsy, severe renal, hepatic or cardiac disease; paralytic
ileus. Pregnancy and lactation.
Nursing
considerations
CLINICAL
ALERT! Name confusion has
occurred between Colazal (balsalazide); dangerous effects could occur. Use
caution.
Assessment
§
History: Allergy to clozapine, myeloproliferative disorders, history of
clozapine-induced agranulocytosis or severe granulocytopenia, severe CNS
depression, comatose states, history of seizure disorders, CV disease,
narrow-angle glaucoma, lactation, pregnancy
§
Physical: T, weight; reflexes,
orientation, IOP, ophthalmologic examination; P, BP, orthostatic BP, ECG; R,
adventitious sounds; bowel sounds, normal output, liver evaluation; prostate
palpation, normal urine output; CBC, urinalysis, LFTs, renal function tests,
EEG
Interventions
§
BLACK BOX WARNING: Use only when unresponsive to
conventional antipsychotic drugs; risk of serious CV and respiratory effects.
§
Obtain clozapine through the Clozaril Patient Assistance
Program. For more information, call 1-800-448-5938.
§
Dispense only 1 wk supply at a time.
§
Monitor WBC carefully prior to first dose.
§
BLACK BOX WARNING: Weekly monitoring of WBC during
treatment and for 4 wk thereafter. Dosage may be adjusted based on WBC count.
Potentially fatal agranulocytosis has been reported.
§
Monitor T. If fever occurs, rule out underlying infection, and
consult physician for comfort measures.
§
BLACK BOX WARNING: Monitor for seizures; with
history of seizures, risk increases as dose increases.
§
Monitor elderly patients for dehydration. Institute remedial
measures promptly; sedation and decreased thirst related to CNS effects can
lead to dehydration.
§
Monitor patient regularly for signs and symptoms of diabetes
mellitus.
§
Encourage voiding before taking drug to decrease anticholinergic
effects of urinary retention.
§
Follow guidelines for discontinuation or reinstitution of the
drug.
§
Educate patient on seriousness of potential agranulocytosis.
Teaching points
§
Weekly blood tests will be taken to determine safe dosage;
dosage will be increased gradually to achieve most effective dose. Only 1 week
of medication can be dispensed at a time and will depend on your white blood
cell count. Do not take more than your prescribed dosage. Do not make up missed
doses, instead contact your health care provider. Do not stop taking this drug
suddenly; gradual reduction of dosage is needed to prevent side effects.
§
If you think you are pregnant or wish to become pregnant,
contact your health care provider.
§
You may experience these side effects: Drowsiness, dizziness,
sedation, seizures (avoid driving or performing tasks that require
concentration); dizziness, faintness on arising (change positions slowly);
increased salivation (reversible); constipation (consult your health care
provider for correctives); fast heart rate (rest, take your time).
§
Report lethargy, weakness, fever, sore throat, malaise, mouth
ulcers, and flulike symptoms.
